JP2024503104A - Peripheral anti-defocus optical device - Google Patents

Abstract

A contact lens for correcting peripheral ocular defocus having a central central zone for correcting refractive error and an aspheric annular anti-defocus zone adjacent to the central zone and extending radially outward from the central zone; or It is an eyeglass lens. The vertical meridian of the anti-defocus zone is less aspheric than the horizontal meridian of the anti-defocus zone, and the horizontal and vertical meridians are blended with gradually changing e values to form a smooth optical surface. [Selection diagram] None

Description

Many people experience vision problems due to many possible medical conditions. One of the most common vision disorders is myopia. Myopia is when the corneal curve of the eye is too steep (i.e., the radius of curvature of the cornea is smaller than normal) or the axial length of the eye is too long to provide sufficient focus, resulting in a change in the retina of the eye. It is a common disorder in which the eye is unable to focus on distant objects because it cannot focus properly. Another disease is known as hyperopia. In hyperopia, the curvature of the cornea of the eye is too flat (i.e., the radius of curvature of the cornea is large compared to normal) or the axial length of the eye is too short to allow for adequate focusing. Because the eyes cannot focus properly, the eyes cannot focus on objects that are far or near. Another vision problem is astigmatism, which occurs when one or more refractive surfaces of the cornea have different curvatures, causing light rays to not be clearly focused at a single point on the retina and appear blurry. Presbyopia is the most common vision problem in adults over the age of 40 due to aging and hardening of the lens. Symptoms of presbyopia can occur even in young adults and children without phacosclerosis as part of a visual acuity problem, known as accommodative dysfunction or deficiency.

In addition to visual acuity issues, normal human vision also requires efficient eye coordination and visual efficiency skills for distance and near tasks. The visual acuity skill of the human eye has three components: accommodation of focusing, vergence for binocular alignment, and oculomotor control for fixation and tracking of codes and objects. . In order for the brain to effectively process messages received by the human eye, it is essential that visual acuity and visual acuity skills remain intact. Additionally, there are subdivided skills within the three visual efficiency skills. A well-trained ophthalmologist or ECP (Eye Care Practitioner) can perform a comprehensive visual acuity examination to detect and manage deficiencies. A well-known traditional test for visual efficiency is the OEP-21 functional test. OEP is an abbreviation for Optometric Extension Program Foundation located in California, USA. Assessment of eye movement control can be analyzed with tests such as NSUCO, SCCO, DEM™, ReadAlyzer/Visagraph test. There is growing evidence of a relationship between visual performance and learning disabilities such as ADHD/ADD (attention deficit disorder with or without hyperactivity) and dyslexia.

Vision correction approaches include wearing glasses, contact lenses, LASIK surgery, and orthokeratology. Traditional approaches to improving visual efficiency are usually through VT (visual training), which is an operant conditioning exercise that teaches patients how to control their eyes for eye teaming. VT treatments use spherical lenses to reduce focusing/accommodative stress and prismatic glasses to compensate for convergence-divergent motion requirements caused by excessive deviation angles. VT typically requires continuous training in the office or home for a few months to a year to build automation of the skill of operant conditioning, but this skill can regress and the skill It needs to be strengthened frequently to maintain it. Supplemental spherical or prismatic devices can be helpful in early VT in difficult cases, but eye teaming adapts to the demands of new focal or convergence-divergent movements provided by additional optical devices and provides short-term symptom relief. It could get worse again. Visual performance problems such as convergence deficiency (CI), convergence excess (CE), and accommodation insufficiency (AI) can cause eye strain and accelerate the progression of myopia. By improving visual efficiency, the progression of myopia can be significantly slowed or stopped.

Despite the above, there remains a need for devices and procedures that further improve visual efficiency.

In one embodiment, the invention provides improved visual efficiency by correcting peripheral ocular defocus using anti-defocus lenses, such as spectacle lenses or contact lenses. The lens includes a central central zone 20 having a lens power for correcting refractive errors, and an aspheric annular anti-defocus (ADF) adjacent to the central zone 20 and extending radially outward from the central zone 20. zone 21. The front or back surface of the lens has a horizontal meridian and a vertical meridian each having an e value, and in the ADF zone, the vertical meridian of the ADF zone has a smaller degree of asphericity than the horizontal meridian of the ADF zone. The vertical meridian of the ADF zone 21 may have an e value of zero, for example, and/or the e value of the vertical meridian may be less than or equal to 1/2 of the e value of the horizontal meridian. The curvature of the lens surface between the horizontal and vertical meridians is blended with gradual changes in e value to form a smooth optical surface. In one embodiment, the vertical meridian of ADF zone 21 may be a monofocal curve having the same power as central zone 20.

If the lens is a spectacle lens, the horizontal meridian and the vertical meridian may be on the front or back surface of the lens, preferably on the back surface. The diameter of the central zone is preferably 1.5-4.0 mm, and the combined diameter of the central zone and ADF zone is preferably 18-28 mm. Such ophthalmic lenses can have an ADF zone that is aspheric and has a horizontal meridian that becomes progressively positive power radially outward from the inner boundary of the ADF zone, and has an ADF zone of +1.00 to +20.0 diopters. It may have an anti-defocus power (ADP), where ADP is defined as the power difference between the outer circumference of the ADF zone 21 and the outer circumference of the central zone 20. Such lenses are useful for treating defocus in hyperopic eyes. Spectacle lenses useful for the treatment of myopic eye defocus can have an ADF zone 21 that is aspheric and has a horizontal meridian whose power becomes progressively negative radially outward from the inner boundary of the ADF zone; This ADF zone has an anti-defocus power (ADP) of -1.00 to -20.0 diopters.

If the lens is a contact lens, the central zone preferably has a diameter of 0.5 to 1.0 mm, and the ADF zone 21 preferably extends radially outwardly from the central zone by at least 3 to 4 mm, and the central zone 20 The combined diameter of the annular ADF zone 21 and the annular ADF zone 21 is preferably 6 to 10 mm. The lens can be, for example, a hard corneal lens, a hard scleral lens, a soft contact lens, etc. Such a contact lens comprises an intermediate zone 24 connected to and extending radially outwardly from the ADF zone 21 and preferably having a zone width of 2.0 to 5.0 mm; It may further include a connection zone 26 extending radially outwardly from the periphery for supporting the contact lens on the cornea, and a peripheral zone 28 coupled to the outer periphery of the contact lens. In contact lens embodiments used to perform orthokeratology, the horizontal and vertical meridians are on the posterior surface of the lens to achieve corneal shaping.

The e-values of the anterior or posterior surfaces of the central zone 20 and ADF zone 21 of the contact lens embodiment are merged to form an aspheric central to ADF zone 20-21, and the horizontal of such central to ADF zone 20-21 is The meridian and vertical meridian can be merged with rotationally progressive e values to form a central to ADF zone with a continuous smooth aspheric surface. This embodiment may have a vertical meridian e value of zero and a single-vision power throughout the center to ADF zones 20-21. The horizontal meridian e value in this embodiment is preferably not zero and may be between ±0.1e and ±3.0e. The rotational progression e value E _x along the axis X ^o of the center to ADF zone can be derived by the following formula:
Ex ₌ SIGN(XR _p- R _c )*(ABS(XR _p ² -R _c ² ) ^)1/2 /d (Formula 2.2)
where XR _p is the radius of curvature at a radially outer point along axis X ^o at distance d, and XR _p is derived from:
XR _p =HR _p +sin(X ^o ) ² *(VR _p -HR _p ) (Formula 2.1)
where R _c is the radius of curvature at the center of the contact lens, HR _p is the radius of curvature at a radially outer point along the horizontal meridian at distance d, and VR _p is the radius along the vertical meridian at distance ``1d''. is the radius of curvature at a point outside the direction.

In contact lens embodiments used for defocus treatment of hyperopic eyes, the horizontal meridian has progressively positive powers radially outward from the central portion of the lens, with an anti-difference of +1.00 to +30.0 diopters. It has a focus power (ADP). The horizontal meridian front surface of such a lens preferably has an e-value of -0.1e to -3.0e, or the horizontal meridian rear surface preferably has an e-value of +0.1e to +3.0e.

In contact lens embodiments used for defocus treatment of myopic eyes, the horizontal meridian has progressively negative powers radially outward from the central portion of the lens, with an anti It has a defocus power (ADP). The horizontal meridian front surface of such a lens preferably has an e-value of +0.1e to +3.0e, or the horizontal meridian rear surface preferably has an e-value of -0.1e to -3.0e.

The invention also provides a method for ameliorating or increasing the visual acuity problem using the above-described lens that corrects defocus in the periphery of a subject's eye. Problems with visual efficiency may include, for example, eye movement dysfunction, accommodative dysfunction, convergence divergence movement disorder, sensory adaptation abnormality, and the like. The method determines the anti-defocus power (ADP) of a lens having a central zone 20 in the central portion of the lens and an anti-defocus zone 21 adjacent to and extending radially outwardly from the central zone 20. may include steps. The central zone has a central focus to form a central image in the retinal fovea to correct refractive errors, and the determined ADP offsets peripheral ocular defocus and improves peripheral fusion and vision. It is sufficient to readjust the peripheral image of the subject's eye to improve efficiency. The steps of determining anti-defocus power (ADP) in this method include checking the subject's baseline visual performance data, selecting an ADF test lens based on the type of visual performance problems experienced by the subject; It may further include testing the defocus strength of the live eye by gradually introducing the selected ADF test lens from a low ADP to a high ADP until an optimal ADP that achieves maximum normalization of the visual performance data is determined. . Thereafter, glasses or contact lenses with the optimal ADP can be provided to the subject. The step of determining the optimal ADP can be repeated after the subject has worn the provided glasses or contact lenses for a predetermined period of time. To improve binocular efficiency problems, or for myopia control in cases of hyperopic eye defocus, the horizontal meridian of the ADF zone 21 is aspheric and gradually extends radially outward from the inner border of the ADF zone. It has a positive power and preferably has an ADP of +1.00 to +20.0 diopters.

To treat defocus in myopic eyes, the horizontal meridian of the ADF zone 21 is aspheric and gradually becomes negative in power radially outward from the inner boundary of the ADF zone, preferably from -1.00 to -20. It has an ADP of 0 diopters. In one embodiment, a minimum of 0.50 diopters relative to the front (more nearsighted) or backwards (more farsighted) in the peripheral foci measured at 10 degrees on each side (N10 and T10) of the subject's retinal fossa. , a substantial anti-defocus effect is induced in the subject's eyes. In another embodiment, the subject has at least 2.00 diopters relatively forward (more nearsighted) or backwards (more farsighted) in peripheral focus measured at 20 degrees on either side (N20 and T20) of the subject's retinal fossa. A substantial anti-defocus effect is induced in the human eye.

FIG. 1 is a schematic diagram showing the formation of an axial image of an eyeball. FIG. 2 is a schematic diagram showing the formation of a parallel axis image of the eyeball. FIG. 3 is a cross-sectional view taken along line 3-3 of FIG. 4 of an anti-defocus (ADF) contact lens embodiment of the present device. FIG. 4 is a plan view of the upper side (front surface) of the contact lens of FIG. 3. FIG. 5 is a plan view of the lower side (rear surface) of the contact lens of FIG. 3. FIG. FIG. 6 is a cross-sectional view of a myopic anti-defocus (M-ADF) orthokeratology contact lens embodiment of the present device taken along line 6-6 of FIG. FIG. 7 is a plan view of the contact lens of FIG. 6. FIG. 8 is a cross-sectional view of a hyperopic anti-defocus (H-ADF) orthokeratology contact lens embodiment of the present device taken along line 8-8 of FIG. 9. FIG. 9 is a plan view of the contact lens of FIG. 8. FIG. 10 is a front view of one embodiment of the spectacle lens of the present device. FIG. 11 is a diagram of Panum's fusion sphere.

DEFINITIONS As used herein, the following terms and variations thereof shall have the meanings set forth below unless the context in which the term is used clearly indicates otherwise.

"AC/A ratio" means the ratio of accommodation convergence AC (in prism diopters) to accommodation to stimulus A (in diopters). The most common method for determining this ratio is the gradient method (or gradient test), in which a spherical lens (usually +1.00D or -1.00D) is placed in front of each eye and the accommodative power is varied, then the near vision Measure the oblique position. This is expressed as AC/A=(α-α')/F, where α is the phoria for near vision and α' is the phoria when seen through a lens of power F at the same distance. Deviations are measured in prismatic diopters, with + representing esotropia and - representing exotropia.

Accommodative dysfunction is a problem with the accommodation system that allows the eye to change optical power, maintain a sharp image, and focus on objects as distance changes. . There are several types of accommodative dysfunction that involve a diagnosis of one or more of the following: (1) accommodative insufficiency, (2) accommodative infacility, and (3) overaccommodation.

"Addition power (ADD)" refers to the difference in refractive power between the distance vision power and the near vision power of a lens. For glasses, ADD is measured in a plane 12 mm in front of the anterior corneal surface. For any other device with a trajectory closer to or farther from the anterior corneal surface, the ADD is calculated using the vertex correction formula Fc=F/(1-xF) for distance, respectively. Increase or decrease. In this case, Fc is the power corrected to vertex distance, F is the power of the original lens, and x is the change in vertex distance in meters.

"Anti-defocus (ADF) device" means an optical device, such as eyeglasses, soft contact lenses, rigid contact lenses, orthokeratology lenses, or intraocular lenses, that corrects the refractive error of the eye and focuses it on the retinal fossa. a central optical zone 20 for forming a focal point and adjacent to and outwardly from the central optical zone 20 for inducing a posterior (longer) or anterior (shorter) peripheral focus and correcting peripheral ocular defocus; An optical device having a peripheral anti-defocus zone 21. A myopic anti-defocus (M-ADF) device that induces a backward (longer) peripheral focus to offset defocus in myopic eyes and a forward (shorter) peripheral focus to offset defocus in hyperopic eyes. A hyperopic anti-defocus (H-ADF) device is set up to induce hyperopia.

The "anti-defocus power" (ADP) of the ADF device is determined by (A) the outermost circumference (periphery) 21c of the ADF zone 21, and (B) the outermost circumference (periphery) 20c of the central zone 20 (ADF zone 21). (corresponding to the inner boundary part 22), that is, ADP=AB. ADP has a positive power in H-ADF devices and a negative power in M-ADF devices.

"ADP effect" is a substantial anti-defocus effect when an ADF device is worn on the human eye, and the peripheral refraction when the ADF device is worn is compared to the baseline peripheral refraction when the ADF device is not worn. Comparisons can be made with an open field refractometer or a Shack-Hartmann system. ADP effect at a specific angle of deviation from the fovea = AB. The deflection angle for measuring ADP is usually set to 10°, 20°, 25°, and 30° (degrees) horizontally to each side of the retinal fovea (nasal and temporal).

"Associated phoria" is defined as the amount of prism required to make the fixation disparity zero.

The "back surface" of a lens is the surface from which light exits the lens in normal use. For example, in the case of a contact lens, the posterior surface is the surface that contacts the subject's eyes when the subject wears the lens.

"Base curve" refers to the curvature of the back surface of a contact lens.

"Binocular fusion" refers to a type of vision that allows two eyes to perceive their surroundings using a single binocular image. Binocular fusion occurs only in a small portion of the peripheral visual space where the eyes are fixating. A curve called the empirical horizontal horopter 62 passes through the fixation point in the horizontal plane. Also, the empirical vertical horopter is tilted away from the eyes above the fixation point and towards the eyes below the fixation point. These horizontal and vertical horopters 60 indicate the center of the volume of visual unity. Within this thin, curved volume, objects near and far from the horopter appear as a single object. This volume is known as Panum's fusion sphere 64 (see Figure 11). Double vision occurs outside of Panum's fusion zone.

Convergence is a phenomenon in which the eyeballs rotate inward to focus on an object, and the degree of rotation indicates to the brain whether the object is near or far. For convergence, the near triad occurs, the eyes converge, the accommodative function is activated, and the pupils constrict.

A "contact lens" is a lens that is placed on the outer surface of a subject's eye.

The "curvature" or "radius of curvature" of a lens is generally measured in millimeters (mm) and expressed in diopters or mm. When expressed in diopters, the curvature is specified by the appropriate refractive index. For example, in contact lenses, when the curvature is expressed in diopters, the refractive index of air and tears is considered along with the refractive index of the lens material when determining the curvature, but for glasses, only the refractive index of the air and lens material is required. . For other lenses, such as thick lenses or intraocular lenses, appropriate formulas and refractive indices can be used, as is well known to those skilled in the art. Curvature can be determined by radial range using a topography device or appropriate refraction information.

"Defocus" refers to a focal position moving away from a detection surface such as a retinal surface along the optical axis. Defocus generally reduces the sharpness and contrast of an image. The edges of a scene that should be sharp and high-contrast begin to change gradually, making small details in the scene blurry or invisible.

The "DEM (trademark) test" is a Developmental Eye Movement Test, which incorporates a subtest of vertically arranged number naming, which evaluates eye movement function using horizontally arranged numbers. provide the means. The DEM™ test was developed by Jack Richman, OD, Ph.D., and Ralph Garzia, OD, Ph.D.

A "diopter" (D) is a unit of refractive power and is equal to the reciprocal of the focal length (in meters) of a given lens or portion of a lens.

Divergence is the opposite of convergence, and is the ability of a subject to turn both eyes outward to see distant objects. This skill is needed for distance activities such as reading the blackboard at school, driving a car, and watching television. Divergence requires the opposite phenomenon of the near triad: the eyeballs diverge, accommodation is inhibited, and the pupils slightly dilate.

The "e value" is an index indicating the eccentricity of the cornea, and a value of zero indicates a perfectly spherical cornea. Negative e-values indicate a flat central zone and a steep intermediate periphery (oblate plane), while positive e-values indicate a steep center flattening radially outward (ellipsoidal plane).
"Fixation disparity" is the tendency of the eyes to drift in the direction of strabismus. Strabismus or latent strabismus is defined as a condition in which the primary position or the moving eye is maintained at the fixation point only under stress, and refers to a condition of convergence-divergent movement without fusion. Fixation disparity refers to a small deviation in which the image is slightly shifted from its corresponding point, but still within the fovea in normal fusion and binocular vision. This shift may be vertical, horizontal, or both. Strabismus interferes with binocular vision, while fixation disparity maintains binocular vision but can reduce the patient's stereopsis level and cause eye strain.

A "focal point" is the point at which light rays from an object or target are focused, such as by refraction.

The "fovea" is the part of the eye located in the center of the macular region of the retina. The fovea is the area responsible for clear central vision, which humans need for reading, watching TV and movies, driving, and any activity where seeing details is paramount. be. The diameter of the human fovea is approximately 1.2 mm to 1.5 mm, corresponding to approximately 4 to 5 degrees of vision (2 to 2.5 degrees to either side of the optical or visual axis). Best corrected visual acuity (BCVA) is approximately 20/20.

The "front" of a lens is the surface on which light enters the lens in normal use. For example, in the case of a contact lens, the anterior surface is the outwardly facing surface that is in contact with air when worn on a subject's eye.

A "horopter" is a trajectory of points in space that have the same parallax as fixation. This can theoretically be defined as a point in space that is projected onto corresponding, anatomically identical points on the subject's two retinas. "Theoretical horopter" or "Veidt-Muller circle" means a theoretical geometric circle passing through the optical centers of both eyes, on which points adjacent to the fixation point are theoretically is located at the corresponding retinal point. The theoretical horopter should be a circle passing through the fixation point and the nodal points of both eyes. The "empirical horopter" is an experimentally determined ellipse passing through the optical centers of both eyes, on which points adjacent to the fixation point are perceived as stimulating the corresponding retinal point. . The shape of the empirical horopter deviates from the theoretical horopter.

"Image shell" refers to the generally concave area of sharp focus created by the refractive system of the eye with corrective lenses (contact lenses and glasses).

An "intraocular lens" (IOL) is a lens that is implanted in the eye and can replace or coexist with the eye's crystalline lens.

"Accommodation delay" refers to the difference between the accommodation stimulus (+2.50D at a 40 cm target) and the accommodation response (focusing), where the stimulus is closer than the response. Accommodation delay = (accommodative stimulus - accommodative response), and the value is positive.

“Accommodative lead” refers to the difference between the accommodative stimulus and the accommodative response, where the response is closer than the stimulus. Regulatory lead = (modulatory stimulus - regulatory response), and the value is negative.

"Lens" refers to an optical element that converges or diverges light, particularly a device that is not a tissue or organ of a subject.

"Macular persistence" refers to visual field loss that preserves vision in the central part of the visual field, known as the macula. It appears in people who have damage to one hemisphere of the visual cortex and occurs simultaneously with bilateral homonymous hemianopia or homonymous quadrantopia. Macular persistence can be determined by visual field testing. The macula is defined as an area approximately ±8 degrees around the center of the visual field. Because there is involuntary eye movement within 1 to 2 degrees, visual acuity in the 3 degree or higher range must be maintained for a patient to be considered to have macular persistence.

``Macular splitting'' is the opposite effect of ``macular persistence,'' resulting in loss of visual acuity in the central half of the visual field.

A "meridian" generally refers to an imaginary straight line extending along the curved surface of a lens. The "horizontal meridian" is a line that passes through a plane parallel to a surface that supports the lens user, such as the floor or the ground, when wearing the lens. A "vertical meridian" is a line that is perpendicular to the horizontal meridian and extends through a plane that is generally parallel to the sagittal plane of the user wearing the lens.

The "NSUCO Eye Movement Test" is an approach to assessing fine visual motor performance tests developed by experienced clinicians at NSUCO (Nova Southeastern University College of Optometry). The equipment required to perform this test is minimal.

"Ocular defocus" refers to gradual forward (short focus, i.e., myopic eye defocus) or backward (long focus, i.e., hyperopic eye The image foci of the eyeball is defocused. Forward (myopic) or backward (hyperopic) defocus is a combination of optics and eye shape. Hyperopic eyeball defocus, in which the peripheral retinal shell is short, is often seen in myopic eyes. Myopic ocular defocus, in which the peripheral retinal shell is long, is common in hyperopic eyes.

"Oculomotor dysfunction" refers to a problem with the oculomotor system that has one or more problems with fixation, saccadic eye movements, and/or tracking eye movements. This impairment interferes with the ability to read effectively and limits or reduces reading comprehension.

When describing light passing through a lens, "on-axis" refers to a direction approximately parallel to the optical axis of the lens. When light from an object enters the lens from a direction substantially on the optical axis or substantially parallel to the optical axis, the object is called a central object, and the image formed by the lens is called a central image. In the ocular vision system, the on-axis image is conjugate to the foveal portion of the retina (see Figure 1).

When describing light passing through a lens, "off-axis" refers to a direction that is not substantially parallel to the optical axis of the lens, so that the incident light that enters the lens diverges at an angle greater than zero from the optical axis. In an ocular vision system, the off-axis image is conjugate with retinal regions outside the foveal portion of the retina, in particular with parafoveal or perifoveal regions (see FIG. 2). Further off-axis can be defined as "paraxial" when the incident light diverges from the optical axis of the vision system at an angle of 2° to 10° and enters the optical device.

The "optical axis" of an optical device, such as a lens, is a line about which some degree of rotational symmetry is centered, about which the device is radially symmetrical.

The "P value" (p) is a quantity derived from the e value (e) by the formula p=1-SIGN(e) ^{* e2} , where SIGN indicates the same positive or negative value as the e value. That is, when e<0, SIGN(e)=-1, and when e>0, SIGN(e)=+1. The p-value for a prolate corneal surface is less than 1.0, and the p-value for an oblate corneal surface is greater than 1.0. A perfectly spherical cornea has a p value of 1.

"Fusion sphere of Panum" refers to the area in front or behind the horopter where binocular monovision exists. It is narrowest at the fixation point and widens at the periphery (see Figure 11). Within the region of the panum, which includes the horoptera, a single image is seen by both functionally normal eyes, but outside the region of the panum, a double image is seen in front and behind. Any object outside of Panum's range causes diplopia (double vision).

The "parafoveal" refers to the intermediate region around the fovea, spaced 0.5 mm radially outward, where the ganglion cell layer contains cells in more than 5 rows and the highest density of cone cells. It consists of cells. The outermost zone of the parafovea corresponds to a visual angle of approximately 8-10° (4-5° to either side of the optic or visual axis). Best corrected visual acuity (BCVA) in this zone can be 20/50 (0.4 log MAR) to 20/20 (0 log MAR).

The "perifovea" refers to the outermost region of the macula found 1.5 mm around the parafovea, where the ganglion cell layer contains 2 to 4 rows of cells and whose visual acuity is less than optimal. It is a place that is. The outermost circumfoveal zone corresponds to a visual angle of approximately 18-20° (9-10° to either side of the optical or visual axis). Best corrected visual acuity (BCVA) in this zone is 20/50 (0.4 log MAR) to 20/100 (0.7 log MAR).

The "peripheral refraction" of the eye can be measured with wide-view (or open-field) refractometers, such as the New Japan NVision-K5001 or the Grand Seiko WR-5100K, which have a wide view window and can be measured with both eyes. The subject can naturally look into the window and fixate at any distance and direction, allowing the subject to relax during the measurement.

Phoria is a misalignment of the eyes that occurs only when binocular vision is disrupted and both eyes no longer see the same thing. This misalignment of eyes starts to appear when you are tired, and does not always occur. Oblique position can be diagnosed by performing a cover/cover test.

"ReadAlyzer/Visagraph" is a hardware and software package. It uses goggles that fit precisely over the patient's face to scan the tiny movements of the eye as it targets various visual signals on a test page. The goggles are connected to a computer running software that analyzes, displays, and stores the data.

"Refractive power" or "power" is the degree to which a lens converges (or diverges) light. The power of the lens is equal to the reciprocal of the focal length in meters, D=1/f, where D is the power in diopters and f is the focal length in meters. "Plus power" refers to the degree of convergence of light that allows the lens to focus on nearby objects, and "minus power" refers to the degree of divergence of light that allows the lens to focus on distant objects.

"Retinal correspondence" refers to either normal retina correspondence (NRC) or abnormal retina correspondence (ARC). NRC is a condition of binocular vision in which both fossa work together as corresponding retinal points, resulting in images being fused in the occipital cortex of the brain. ARC is a binocular sensory adaptation to compensate for strabismus. The fovea of the non-deviated eye and the non-fovea (usually parafovea) of the deviated eye cooperate, allowing binocular fusion single vision.

A "rigid contact lens" is a contact lens that does not change shape to take on the contours of the corneal surface when worn on the eye. Rigid contact lenses are typically made from PMMA (polymethyl methacrylate) or gas permeable materials such as silicone acrylates, fluoro/silicone acrylates, and cellulose acetate butyrate, whose main polymer molecules generally absorb or attract water. I don't do it.

The "SCCO eye movement test" is an approach developed by the Southern California College of Optometry (SCCO) to evaluate fine eye movement abilities performed by experienced clinicians. In this test, fixation maintenance, tracking, and saccades are scored from +1 to +4.

The "Shack-Hartmann System" can be used to measure lens aberrations of the eye. A high resolution visual display shows the spot the user sees through the lenslet array. The user then manually shifts the displayed spots (ie, the generated wavefronts) until the spots are aligned. The magnitude of this shift becomes data for estimating primary parameters such as the radius of curvature, and further errors due to peripheral defocus and spherical aberration.

A "soft contact lens" is a contact lens that is typically made of a material whose surface contours to the corneal surface when placed on the cornea. Soft contact lenses are typically made of materials containing about 20-70% water, such as HEMA (hydroxyethyl methacrylate) or silicone hydrogel polymers.

"Glasses" are frames with lenses that are worn in front of the eyes. This frame is usually supported on the bridge of the nose by arms that go over the ears.

"Spherical aberration" refers to a deviation in a device or part of a device from the focus of a perfect lens that focuses all incident light rays at a single point on the optical axis.

"Stereoscopic vision" refers to the recognition of depth based on visual information obtained from two eyes. Because human eyes have different lateral positions on the head, the images projected into the eye sockets result in two images that differ slightly, primarily in the relative horizontal position of the object. This difference in position is called image parallax, and is processed in the visual cortex to provide depth perception. Although binocular fusion is necessary for stereoscopic vision, the reverse is not necessary.

As used herein, "suppression" refers to a suppression mechanism that completely or partially cancels one of two monocular images viewed with both eyes. The adaptive value of this mechanism is to avoid confusion and double vision. Intermittent central suppression (ICS) is a disorder of normal binocular vision in which central vision in one eye turns on and off while peripheral fusion is maintained. This causes repeated and intermittent loss of central visual sensation. Monocular suppression during binocular fusion is characterized by a short suppression period limited to the central 2 to 3 degrees. Monocular suppression lasts about 2-3 seconds, followed by binocular fusion, which lasts about 2-3 seconds, and the same eye or the other eye may be suppressed for about 2-3 seconds. ICS may always occur in one eye or may occur alternately as binocular ICS.

A "translating" bifocal or multifocal contact lens is a lens that has at least two distinct regions or zones for distance vision and near vision, respectively.

``Strabismus'' is a constant misalignment of the eyes. Even when both eyes are open and trying to work together, a large angular misalignment can be seen. Strabismus is a static position in which the eyes move when unfused by covering the eyes or repeatedly covering both eyes alternately.

"Visual acuity" refers to the sharpness of focus achieved by a particular optical system (eg, a lens and/or the cornea of an eye).

"Viewing angle" is the angle that a light ray makes with the visual or optical axis, preferably measured from the principal plane.

A "visual axis" is a straight line extending from an object visible through the center of a subject's pupil to the foveal region of the retina of the human eye.

"Visual efficiency" refers to the eye's ability to track, converge, and focus quickly. There are four systems used to evaluate visual performance skills: the eye movement system, the accommodation system, the convergence-divergence system, and the sensory system. Visual efficiency is necessary to properly process visual information. Problems in this area are generally referred to as visibility problems.

"Vergence-divergence movement disorder" is a problem with the vergence-divergence system, in which both eyes move in opposite directions at the same time to obtain or maintain a single binocular vision when the distance of an object changes. . There are several types of convergence-diffusion disorders: (1) fused convergence-diffusion movement disorder, (2) convergence deficiency (CI), (3) basic external oblique position, (4) hyperdispersion, ( 5) convergence excess (CE), (6) basic internal oblique position, and (7) under-diversity.

"Visual information processing ability" refers to the brain's ability to utilize and interpret visual information from the world surrounding an individual. Converting light energy into meaningful images is a complex process that involves many brain structures and higher-order cognitive processes.

Variations of the terms "comprise" and "comprising" and "comprises" do not exclude other additions, components, integers or steps. The terms "a", "the" and similar referents used herein should be construed to include both the singular and the plural, unless the context clearly indicates otherwise. It is.

Formula The following formula is used to determine the e value of the horizontal meridian and vertical meridian of the lens. R _p is the radius of curvature at the peripheral distance d, R _c is the radius of curvature at the center, and d is the distance between the peripheral point and the lens center. E is eccentricity and p is p value.
(Formula 1.1)
E=SIGN(R _p -R _c )*SQRT(ABS(R _p ² -R _c ² ))/d
(Formula 1.2)
p=1-SIGN(E)*E ²
(Formula 1.3)
R _p =SQRT(R _c +SIGN(E)*d ² e ² )

The non-uniform rotational aspheric ADF zone along the axis ^Xo can be formulated as follows. E _h is the e-value in the predetermined horizontal direction (0 to 180 degrees), E _v is the e-value in the predetermined vertical direction (90 to 270 degrees), and HR _p is the distance ``d'' radially outward along the horizontal axis. VR _p is the radius of curvature of a point radially outward by a distance 'd' along the vertical axis, XR _p is the radius of curvature of a point radially outward by a distance 'd' along the axis X ^o , E _x is the e value of the axis X ^o .

Calculate HR _p and VR _p by applying equation 1.3.
HR _p = SQRT(R _c +SIGN(E _h )*d ² E _h ² )
VR _p =SQRT(R _c +SIGN(E _v )*d ² E _v ² )
(Formula 2.1) XR _p =HR _p +sin(X ^o ) ² *(VR _p -HR _p )
Applying equation 1.1, _Ex :
(Formula 2.2) E _x = SIGN(XR _p -R _c )*(ABS(XR _p ² -R _c ² )) ^1/2 /d

Visual efficiency Visual efficiency refers to the eye's ability to track, converge, and focus quickly. Visual efficiency is necessary to properly process visual information. Visual acuity, refractive errors, eye movements, accommodation, and binocular vision are all important factors in visual efficiency. Abnormalities or impairments in one or more of the above functions can affect visual attention and cause learning-related visual impairments. Problems with visual efficiency, especially binocular vision dysfunction such as accommodative deficiency (AI) and convergence deficiency (CI), can cause eye strain and malocclusion, and may be one of the causes of rapid progression of myopia.

A large amount of research has been conducted on the relationship between visual acuity and reading learning performance. The most well-known case analysis system for optometry performance is the Optometry Extension Program (OEP-21 Item) analysis, in which tests are categorized by number codes. Several other analyzes and clinical criteria have been proposed to help guide decisions. OEP analysis examines refraction, oblique deviation, vergence divergence, and accommodative systems at both near and far distances. A comprehensive evaluation may also include checking the oculomotor and sensory systems.

The skill of measuring visual efficiency is well known to trained ophthalmologists (ECPs), especially behavioral optometrists and ophthalmologists (OD/OMDs). The most important goal in human visual acuity is to maintain the spatial alignment of the eyes and focus them to form a single, fused, sharp image at all distances. . Diagnosis and classification of visual acuity abnormalities and functional disorders is usually performed by comparing measured functional data with standard clinical data for corresponding items. Relative magnitudes and ranges between several measurement items were also developed from graphical analysis of the OEP-21 items to help quickly assess whether vergence-divergent movement or accommodation deficits are present. Need to be checked against clinical standards. Standard clinical data and criteria for cross-checking visual acuity are well known to experienced ECPs, including, but not limited to, the Sheard and Pervical criteria.

In addition to checking accommodative and vergence-divergent movement data to assess whether there may be problems with visual performance, we can assess the quality of binocular vision more directly by assessing the sensory system. can be measured. Clinically, ophthalmologists typically assess the sensory system by checking binocular fusion, fixation disparity, retinal correspondence (ARC or NRC), suppression, intermittent central suppression (ICS), and three-dimensional stereopsis. do.

Strabismus, or strabismus, is a condition in which the eyes are not aligned correctly when viewing objects. This symptom may occur intermittently or constantly. The eye that fixates an object may change between both eyes, or it may always be one eye. Deviation can occur intermittently or continuously. Although strabismus is a serious binocular vision abnormality, it does not usually present a significant problem with visual performance. The strabismus' sensory system typically adapts by inhibition and ARC to eliminate confusion so that the reading task has no or little disturbance.

On the other hand, visual performance problems in non-strabismus, while not noticeable unless there is significant eye deviation, can significantly impair reading comprehension and academic performance. This latent binocular vision impairment is usually ignored or misdiagnosed as attention deficit disorder (ADD/ADHD) or dyslexia, missing opportunities for early detection and improvement.

An experienced ECP will perform a comprehensive visual examination, including checking the health of the eyes, checking refractive vision, and evaluating oculomotor, accommodative, convergence-divergent, and sensory visual acuity skills. Able to diagnose non-strabismic vision problems. In children with developmental delays, visual processing skills can be examined to detect deficits in perceptual skills. If non-strabismic vision problems are discovered, the child may need to consult a behavioral optometrist or ophthalmologist for further management. Treatment strategies may include prescribing eyeglasses or contact lenses for correction of refractive errors, accommodation disorders, and/or oblique deviations. Refractive errors and accommodative disorders must be corrected or corrected with plus or minus spherical power, while clastic deviation and convergence divergence movement disorders can be aided or corrected with spherical or prismatic lenses. . Specialists can determine spherical or prismatic power by manipulating the type of problem in the measured oblique angle, accommodation, convergence range, and most importantly visual acuity determined on the comprehensive examination. . The spherical power or prismatic power determined for correction may only work temporarily or over a limited distance, such as at arm's length. This is because the correction power provided is typically to reduce visual stress and not to ameliorate or repair efficiency problems. The necessary corrective spherical power and prism power are usually different for long distance and short distance. With the help of corrective glasses, the eyes adjust to the new declination and the demands on accommodative and convergence power are reduced, but the impairment may worsen over time.

Visual Training (VT) is the treatment of choice for patients who are determined to be inattentive due to visual performance problems, particularly reading/learning difficulties or behavioral problems. This therapy is designed to leverage behavior modification and biofeedback to enable new insights and alternative approaches that promote efficient, effective, and ultimately effortless eye teaming. ing. VT requires office and home training courses. Improvement usually takes at least three months. Acquired skills can be regressed and booster training is required periodically after the initial training course.

Corrective spherical or prism glasses and contact lenses improve the central fusion in the foveal region of the retina, which is the main area of the sensory system for achieving fused, clear binocular vision, and improve the clarity of binocular images. It helps visual efficiency by improving it. Typically, positive spherical power is added to assist the accommodative system to obtain clearer near vision at arm's distance, such as in presbyopia or accommodative deficits (AI). The added negative or positive spherical power changes the convergence divergence system by changing the accommodative vergence, improving the deviation angle and binocular fusion range. When adding spherical power to glasses to improve visual efficiency problems, the wearer may need two sets of glasses, one for near distance and one for far distance. Alternatively, patients may wear bifocal or multifocal glasses or contact lenses for daily work or school.

Correction prisms are commonly incorporated into eyeglasses to aid in vergence divergence systems for excessive deviations at distance or near distance, such as fusion vergence dysfunction or convergence deficiency (CI). The power of the prism is not prescribed to improve the convergence divergence system or correct the eye, but rather to move the entire image horizontally or vertically into the fovea of the retina of the deviated eye for binocular vision. added to facilitate fusion. Typically, the required relieving prism powers are different for distance and near vision, requiring patients to change glasses when viewing at different distances. It is extremely inconvenient for daily life, especially school life. The mitigating prism does not improve the oblique deviation or improve the vergence-divergent system, but it does improve the central fusion at a certain distance to satisfy the sensory system. As the patient gradually adapts to the added prism, the oblique angle widens, and dysfunction and asthenopia may recur, requiring more prisms to relieve symptoms.

Spherical or prismatic glasses can be incorporated to improve the sensory system and more easily fuse the foveal images. On the other hand, visual training (VT) can expand the fusion zone of extraocular muscles and maintain central fusion without destroying the image. In other words, VT trains the extraocular muscles and brain control to correct the oblique angle like a prism; VT does not usually improve the oblique angle. The improvement in conditioning after successful VT may regress without regular reinforcement, and the sensory system may abnormally adapt on its own with some inhibition to alleviate eye strain and confusion.

Patients with visual acuity problems may adapt to impairments in several ways if not properly identified and treated. The most common adjustment for children with vision problems is to avoid near vision tasks, and they may be labeled as having attention deficit disorder (ADD/ADHD) or dyslexia in school. Another adaptation is to suppress one eye and look with one eye at a time. This phenomenon is involuntary and may be suppressed in one eye at a time, or in both eyes alternately.

High myopia may develop more rapidly as an adaptation to performance problems, as the need for strong convergence and/or accommodation at arm's distance is reduced during near vision tasks. If one eye is always suppressed, myopia in the eye that looks at near vision tasks (the unsuppressed eye) can develop more quickly than in the other eye, potentially resulting in anisometropic myopia. In near vision tasks, when the more nearsighted eye sees much more clearly than the other eye, the development of anisometropia may avoid diplopia when visual performance is compromised. Thus, myopia and anisometropia can be adaptations to visual efficiency problems. If we ignore the fundamental visual efficiency problem and correct only induced errors such as myopia and anisometropia, the induced errors will rapidly worsen and the correction power for new adaptations will decrease. Myopia with convergence deficiency (CI) often progresses rapidly because children cannot avoid near vision tasks at school. Myopia is an adaptation to the intense convergence and accommodative demands of AI and CI, while new glasses for distance vision break that adaptation, leading to further myopia and less intense visual demands at arm's distance. It is necessary to set up new adaptations for A similar anisometropic adaptation occurs in CI, with the near-sighted eye being used for near-vision tasks and reading performed with only one eye, which requires less convergence. If glasses are prescribed that completely correct anisometropia without correction for CI, CI patients achieve a new adaptation for monocular vision that requires less effort to read or work at arm's distance. As a result, anisometropia may increase. In the case of such CI, myopia and anisometropia may progress rapidly as near vision tasks increase unless the underlying visual efficiency problem is discovered and appropriately corrected.

Currently, binocular vision dysfunction is analyzed by challenging the accommodative and vergence divergence systems with spherical and/or prismatic lenses to determine the power range and correcting the defects with spherical and/or prismatic lenses. ing. Visual training is conditioning training (VT) that teaches patients to perceive certain stimuli and produce appropriate responses. There is still no known physiological or anatomical cause that can be directly ameliorated to permanently cure most visual acuity problems. The most common convergence-divergent system problem is convergence insufficiency (CI), with a prevalence of 2-17%, average of 13%, low AC/A ratio, high near-field ectopia, The positive (convergence) convergence area is reduced, possibly accompanied by accommodation deficit (AI). When prescribing glasses for CI patients, adding power to correct for accommodative delay to aid near vision can drive the eye outward and increase ectopia at near distance. The AC/A ratio of CI is usually lower (3/1 to 6/1).

The above-mentioned binocular evaluations, corrective lenses, and VT for visibility problems are all aimed at correcting the fusion or range of motion of the foveal image. New findings show that by adding positive power only to the periphery of a contact lens, it is possible to immediately and significantly reduce near-field ectopia without compromising distance vision, and at the same time reduce near-field accommodative lag. discovered. In other words, by manipulating the defocus of the peripheral eyeballs in the image, which is not taught in the conventional concept of conventional eye teaming, it is possible to justify the spatial relationships of all distances and improve the problem of visual efficiency.

Another discovery is that esotropia (medial deviation) at short distances can be improved by using the above-mentioned contact lenses in conditions of hyperconvergence (CE). CE is characterized by high AC/A, high internal oblique position, and reduced negative (divergent) fusion range at short distances, which is almost the opposite of CI in conventional diagnostic and remedial classification. It is. It is ironic that the same central distance (CD) multifocal lens can instantly restore the spatial relationships of CE patients to those of CI patients. The sensory system improves dramatically in both CI and CE conditions by reducing or eliminating the prism power required for binocular fusion and by reducing or eliminating fixation disparity and associated tropism. do.

In order to treat both CI and CE using CD multifocal lenses, we need to know how multifocal lenses change the sensory system for binocular fusion in the peripheral part of the eye. . To understand binocular fusion, it is necessary to know the univision Panum's fusion sphere, as defined by theoretical and empirical horopters. Binocular fusion occurs only in a small portion of the peripheral visual space where the eyes are fixating. Passing through the fixation point in the horizontal plane is a curve called the empirical horizontal horopter. Also, the empirical vertical horopter is tilted away from the eyes above the fixation point and towards the eyes below the fixation point. These horizontal and vertical horopters mark the center of the volume of visual unity. Within this thin, curved volume, objects near and far from the horopter appear as a single object. This volume is known as the Panum fusion area, and double vision occurs outside of the Panum fusion area.

Conventional visual acuity and binocular fusion are defined for the retinal fossa with the most correctable visual acuity for binocular fusion and stereopsis. It is true that if a person has strabismus and the central images of both eyes cannot be fused, he or she will have diplopia, monocular central suppression, or amblyopia, and the diagnosis and management of these problems will depend on the foveal region. Resolution in the peripheral retina is generally much lower, and correctable visual acuity is much worse. Peripheral binocular fusion is also not easy to qualify or quantify, so peripheral vision is usually ignored and considered unimportant for binocular fusion. However, despite having very sharp visual acuity of 20/20 or better, the central visual field is only 1% of the total visual field, so 99% of the peripheral visual field and its fusion are required to maintain binocular fusion for eye teaming. is thought to play an important role. The fusion sphere models of Horopta and Panum best illustrate the importance of peripheral fusion. The area of Panum is narrow at the fixation point (fovea) and gradually widens toward the periphery (periphery of the retina). When fixing a target at the center and fusing the central images of both eyes, it is necessary to fuse the peripheral visual fields of both eyes as widely as possible in order to improve visual efficiency. The arrangement of Panum's fusion sphere is an adaptation to facilitate peripheral fusion even when the peripheral retinal resolution is low. Oblique rays of peripheral vision enter the peripheral cornea and form an image on the peripheral retina. Oblique light rays incident on the peripheral cornea induce oblique astigmatism, which results in oblique astigmatism (ATR) at the horizontal meridian (J ₀ ) and direct astigmatism at the vertical meridian (J ₉₀ ). In this way, the peripheral retina recognizes the peripheral image for binocular fusion. Therefore, the characteristics of image perception and binocular fusion in the peripheral retina are significantly different from those in the fovea, and it is more difficult to detect peripheral fusion using a method that detects central fusion.

High-quality fusion for an efficient sensory system has the sharpest central visual field at the fovea and a blurred toroidal peripheral visual field at the periphery of the retina, both of which contribute to the panum for binocular fusion. It is desirable to be within the fusion zone. The key to binocular fusion is the horizontal empirical horopter. According to the Hering-Hillbrand deviation, the horizontal empirical horopter is flatter than the theoretical horopter at short fixation distances and more convex at long fixation distances. At short fixation distances, the horizontal empirical horopter becomes a concave parabola that is flatter than a circle. At a distance called the abasic distance, the empirical horopter becomes a straight line. Finally, if the fixation distance is farther than the abasic distance, the empirical horopter becomes a convex parabola. In other words, Panum's fusion sphere becomes concave, linear, and convex at different fixed planes.

Investigations of Panum's fusion sphere are typically approached geometrically, including trigonometric analysis of visual axes and angles in space. On the other hand, the accommodative and focal systems should not be ignored, since the convergence and accommodation systems together determine the horopteral plane in space and form a sharp image for the entire retina within the horopteral space. . The width of Panum's fusion sphere is also known as the confusion of accommodation, which corresponds to the vergence angle of both eyes. When we fixate on a nearby point, Panum's fusion sphere becomes wider and the parallax of the image on the retina becomes larger. In other words, if the peripheral image shell is blurred and it is difficult for the peripheral images to fuse within Panam's fusion zone, the fusion in both eyes becomes disturbed or easily damaged even though there is no abnormality in the fusion in the center. . The shorter the visual distance, the greater the parallax, and the more difficult it becomes to maintain fusion.

The macula is essentially an area of the fovea at 4 to 5 degrees central, and projects to different areas of the brain's visual cortex. This is the reason why it occurs. This phenomenon also indicates that the central image and peripheral image can be considered as two separate image shells for fusion. When testing motion fusion in stereograms, we notice that the central image remains fused in stereoscopic vision, but the peripheral images in the outer box become distorted before the central image is broken. The central image shell is essential for clear binocular and stereopsis, which requires precise accommodation, sensory fusion, and motor fusion. On the other hand, the peripheral retina beyond the macula forms a peripheral image shell that is important for the distribution and stabilization of binocular center fusion.

The shape of the eyeball, the optical system such as the cornea and crystalline lens, and the retinal shell that focuses images differ from person to person. The shape of the eyeball may change with physiological growth at a young age (usually before the age of 7 to 9 years), which expands approximately equally in the anteroposterior and equatorial dimensions. Progression of myopia usually increases along the anterior-posterior axis (axial extension), but there is less extension to the peripheral retina and little extension at the equator. The elongation of the axis as myopia progresses may cause a greater change in the focus of peripheral images in the peripheral retina. When myopia is corrected with regular monofocal glasses or contact lenses, myopic axial elongation ultimately results in relative hyperopic ocular defocus that gradually increases outward toward the periphery of the retina. in the human eye by mapping the focal position in on-axis and off-axis viewing angles using commercially available autorefractors (e.g., New Japan NVision-K5001, Grand Seiko WR-5100K, COAS Shack-Hartmann Aberometer). Defocus in the periphery can be objectively detected. Further, in a study using MRI (magnetic resonance imaging), it was discovered that as myopia progresses, hyperopic defocus in the periphery is correlated with deformation of the retinal shell. Changes in retinal curvature in highly myopic eyes are more pronounced in the horizontal meridian than in the vertical meridian, especially in the temporal retina, which can account for significant hyperopic peripheral defocus of the image shell.

When an object is outside the Panum fusion range of a person's fixation point, the image of the object becomes double and cannot be fused, a phenomenon called physiological diplopia, which can occur in both central and peripheral vision. Panam's fusion sphere is narrow in the center and widens towards the peripheral vision. This has low resolution and corresponds to a toppled astigmatic image in the peripheral region of the retina. The peripheral retina is adapted to fuse the blurred and distorted images formed by oblique light rays incident on the peripheral part of the cornea. When fixating at the near point with both eyes for reading, the fovea (4-5 ^o ) is used for fixation and the code is recognized, but the parafovea, perifovae, and peripheral retina are used as saccadic eyeballs. Assists in motor repositioning and binocular fusion. Saccadic eye movements are rapid, conjugate eye movements that shift the center of gaze from one part of the visual field to another. Saccades are primarily used to direct the eye toward objects of interest. Binocular vision for reading is not a static state, but a dynamic state in which the eyeballs move rapidly, pause for a few seconds to focus, and fuse a clear image with both eyes, thereby repeatedly recognizing letters. It is a process.

In the traditional concept, normal binocular vision in free space is defined by the coordination of the accommodative system for focusing at any distance and the vergence-divergent system for aiming at the object for binocular fusion; Both systems were considered only for the integration of foveal images. The fovea covers only 1-2 ^o degrees of visual angle on either side of the visual axis, which is about 1% of the total visual field. The fovea is critical for achieving the highest resolution and sharpest vision, but it is not wide enough to maintain binocular fusion. In order to accurately align the central visual field, it is first necessary to be able to fuse the peripheral visual field. The more image shells there are within Panum's fusion range, the more accurate and efficient fusion of the central image becomes possible. If a wide peripheral image cannot be focused either in front of the retinal shell (shorter focus) or behind (longer focus) and meet the requirements of Panum's fusion sphere for fusion, the eye undergoes peripheral fusion. In order to recover vision and eliminate diplopia and confusion, the patient is forced to seek fixation and focal points that are farther or closer. If the fixation distance required for peripheral fusion is long or short, at least one of the accommodative system and vergence divergence system changes, causing the central image to become blurred and central fusion to be disrupted or impaired. Sometimes. When binocular central fusion is disrupted, diplopia and suppression occur. When central fusion is compromised and uninterrupted, ICS (intermittent central suppression), fixation disparity, and central image blurring occur. The corrupted image may be fused in the Panum's fusion sphere, but the image quality will be poor and may be detected on eye examination as fixation disparity, ICS, accommodative lag, or spasms.

In other words, the mismatch between the central image shell and the peripheral image shell prompts binocular refixation by the vergence divergence system and accommodation system in order to seek a state in which images can be fused in order to prevent double vision. The cost of refixation is that the foveal image is distorted and the quality of visual acuity is reduced, which can result in fixation disparity, ICS, blurring and flickering of vision, etc., which are common symptoms of visual performance problems. Poor vision quality requires frequent focusing by the accommodative system and movement of the head back and forth, leading to oculomotor dysfunction, eye strain, and rapid eye movements, which are common symptoms of visual acuity problems. Myopia progression is caused.

Deviation of the fixation point/focus point from the visual target can be detected in conventional visual performance tests such as the OEP-21 item test, including abnormal external tropism/medial tropia (#8 and #13), abnormal relative accommodation. associated Sheard/Percival criteria failure (#20-PRA or #21-NRA), relative vergence divergence movement (#16A-PRV, #17A-NRV, #16B-PFV, #17B-NFV), or accommodative delay. Detected as an increase (MEM retinoscopy, unfused cross-cylinder examination of #14A-net and #15A-net, fused cross-cylinder examination of #14B-net and #15B-net). Fixation/focus deviation from the visual target can also cause oculomotor dysfunction, which can be detected and evaluated with the NSUCO test, SCCO test, DEM™, and ReadAlyzer/Visagraph.

In other words, this innovation proposes anatomical optical factors that the shape of the human eyeball and the optical system of the eye can cause problems in visual efficiency, and uses an anti-defocus (ADF) optical device to improve the periphery of the eye. Defocus can be measured and corrected by adjusting back and forth, realigning the image shell to fit a wider retinal shell to improve fusion across the visual field. This anti-defocus (ADF) device closely matches the requirements of Panum's fusion sphere from the outer center to the periphery of the retina, and also provides a better center-to-center retina to reduce or eliminate visibility issues. promotes fusion of images.

It is also a new innovation that myopia progression is due to the same anatomical mismatch in which the peripheral image shell does not match the retinal shell at arm's distance for reading. Without being bound by any particular theory, we believe that it is not only optical stimulation that controls human eye growth as stated in the prior art, but also that binocular fusion mismatch is the main cause of changes in eyeball shape. This may be a factor. As evidence, myopia often progresses very quickly among children with CI, especially if patients study CI without avoiding near tasks. When ADF (anti-defocus) contact lenses are prescribed and worn, the CI condition usually improves dramatically, and central fusion is improved even without the use of compensating prisms or VT. It may also stop or slow the progression of myopia. The ADF lens according to the present invention realigns the image shell to the entire retinal shell to fit within the Panum's fusion zone, improves binocular fusion with accurate fixation on the target, and improves binocular fusion with It further facilitates central fusion and focusing, which can be detected by efficiency tests. If visual efficiency problems are improved and eye strain is alleviated, the rapid progression of myopia can be slowed or stopped.

To assess the degree of peripheral defocus in patients with visual acuity problems and to realign the image shell to fit the Panum's fusion sphere to normalize central fusion and focusing, step The use of a series of ADF optical devices with a fixed or gradual peripheral front or back focus is yet another innovation. When introducing an ADF optical device, it is also necessary to monitor the evaluation of peripheral eyeball defocus. Normally, it is difficult to directly detect eyeball defocus in the periphery or displacement of the image shell in the periphery. Once the image shift is corrected by the ADF device, the performance of foveal fusion and visual acuity can be tested, which can be done by repeating the OEP-21 item test, or more simply by repeating the OEP-21 item test. This can also be done by monitoring fixation disparity and binocular fusion/stereopsis to detect foveal fusion. Central fixation disparity may be better recalibrated and relative convergence-divergent movement and/or improved relative coordination may reduce tropia deviation as previously noted in the OEP-21 item test. For subjects with oculomotor dysfunction, improvement can be quantified by repeating the NSUCO test, SCCO test, DEM™, ReadAlyzer/Visagraph before and after wearing the ADF optical device. This comparison is preferably repeated after a few days to a few weeks of wearing the device to allow time to develop a new balance with the new optics. Thereafter, the detected peripheral ocular defocus can be converted to incorporate the ECP into the desired glasses or contact lenses.

There are several conventional methods to correct the visual power problem using spherical or prismatic lenses, such as CI and CE. Prism glasses do not improve tropia, but by deflecting the binocular images outward or inward at a deflection angle that allows binocular fusion without much effort, eye strain can be alleviated for a while. However, patients often become habituated to the mitigating prism and deflect it further, exhibiting greater tropism, and symptoms and/or suppression return. Spherical lenses may indirectly change accommodation through AC/A, adjust oblique deviation, and improve central fusion. However, spherical devices can only function at preset distances. If used for a field of vision other than the set distance, the field of view may become blurred or binocular fusion may be broken. If viewing performance problems due to misalignment of the image shell and retinal shell are proven, the image shell can be modified with a peripheral ADF optical device to better fit Panum's fusion sphere at all distances. The traditional method of visual training (VT) to improve visual performance skills may still further expand the fusion range and help improve subjects' fusion skills, while the ADF optics after training Continuous use of the device requires less training time and boosters.

The shape of the retinal periphery determines how the image shell matches the retinal shell from the center to the periphery. Panum's fusion sphere in the horizontal meridian follows the Hering-Hillbrand deviation, being concave at short fixation distances and convex at long fixation distances. In other words, if the peripheral retinal shell has relatively hyperopic ocular defocus, the fixation distance needs to be farther from the eye for the image shell to enter Panum's fusion sphere. The convex Hering-Hillbrand deviation at distance also indicates the retinal shape of axial myopia, i.e., the retinal shell gradually becomes hyperopic defocused from the center outward. The convergence divergence system for binocular fusion is driven by the retina-retinal shell, while focusing and accommodation are driven by the fovea. It is known that the focal length becomes longer in the case of farsightedness, and the focal length becomes shorter in the case of nearsightedness. In the present invention, hyperopic eyeball defocus requires a long fixation distance from the eyes for binocular fusion, and myopic eyeball defocus requires a short fixation distance from the eyes for binocular fusion.

The Hering-Hillbrand deviation is concave at near, and the concave Panum's fusion zone also gradually widens toward the periphery, so at near, the peripheral defocus of hyperopic eyes decreases, while the peripheral defocus of myopic eyes decreases at near. There may be more peripheral defocus of the eye. On the other hand, the Hering-Hillbrand deviation of Panum's fusion sphere is convex at distance and gradually widens toward the periphery, which may accommodate the peripheral defocus of hyperopic eyes at distance.

Improved visual efficiency Myopic eyes are usually elongated along the anterior-posterior axis, have a long axial length, and have a less elongated peripheral retina, so when corrected with a spherical lens, the foveal image is focused, while the focus is focused behind the retina. Hyperopic defocus, in which the surrounding images are blurred, may occur. Accommodative or monofocal lenses cannot adjust the peripheral defocus of the eye because the foveal image changes and goes out of focus at the same time. The eyeballs use the convergence-diverging system to improve peripheral fusion by performing binocular vision at a distance (weakening convergence) in search of distant but clear peripheral images, and adapting to eyeball defocus in the peripheral areas. Distance viewing for horopteropia allows for better, but not perfect, binocular fusion. The central and peripheral images can enter Panum's fusion sphere due to fusion after refixation, but due to "fixation disparity" (exoFD), "intermittent central suppression" (ICS), or excessive convergence delay There should be a substantial discrepancy, as indicated by . This model has a low convergence deficit (CI) with a low AC/A ratio, an excessive proximal proximation with delayed accommodation (MEM of the OEP-21 item test, #14A and 14A-net, 15A, 14B and 14B). -net, 15B) will also be explained. The eyeball shape suitable for this model is not limited to myopic conditions. When the peripheral retinal shell has a relative hyperopic defocus, the eye can be emmetropic, farsighted, or myopic.

The converse model describes convergence excess (CE) when the peripheral retinal shell has excessive myopic defocus. Hyperopic eyes have a short axial length and a relatively wide equator, so when corrected with a spherical lens, the foveal image is focused, while the peripheral image focused in front of the retina is blurred, resulting in myopic eye defocus. It may be done. At the same time, the image of the fovea is also out of focus, so defocus in the peripheral area of the eye cannot be adjusted by relaxing the accommodative system or using a single-focal optical lens. The eyeballs use the convergence-divergent system to improve peripheral fusion by performing binocular vision at near distance (increasing convergence) in order to obtain clear peripheral images, and adapting to eyeball defocus in the peripheral areas. . Near viewing for horopteropia allows for better binocular fusion, although not perfect for visual acuity. The central and peripheral images may enter Panum's fusion sphere due to fusion after refixation, but exhibit "fixation disparity" (esoFD), "intermittent central suppression" (ICS), or convergence leads. As such, there should be a substantial mismatch. This model has high convergence excess (CE) with AC/A ratio, excessive mesotropia near me with hyperaccommodation (MEM of OEP-21 item test, #14A and 14A-net, 15A, 14B and 14B). -net, 15B) will also be explained. The eye shape suitable for this model is not limited to hyperopic conditions. When the peripheral retinal shell has a relative myopic defocus such that most of the peripheral image shell is focused in front of the retina and there is greater convergence for fixation at near distance due to binocular fusion. , the eyes can be emmetropic, farsighted, or myopic.

Referring to FIGS. 3-5, a peripheral anti-defocus (ADF) optical device, such as a contact lens, spectacle lens, or IOL, includes a central optical zone 20 with refractive power to correct distance vision; The zone corresponds to a viewing angle of approximately 4-5° central angle, corresponding to a 1.5 mm foveal area located approximately 22.6 mm behind the corneal plane of the human eye. The adjacent outer part of the optical device further provides an anti-defocus (ADF) zone 21 with a shorter or longer focal length to move the peripheral image shell forward or backward, respectively, which in the retinal periphery beyond 4-5 degrees of the far foveal zone to at least up to 60 degrees corresponding to the parafoveal (up to 10 degrees), perifoveal (up to 20 degrees), and partial retinal peripheries of the eye 14; Focus the image.

The novel methodology of the present invention can be used to design peripheral anti-defocus (ADF) devices for diagnosing and ameliorating visual performance problems and related myopia control. The central power of the optical device in the foveal region of the eye 14 is always for the correction of distance vision. When the peripheral ADF zone 21 has a more positive power and brings the peripheral focus forward, it is called a hyperopic anti-defocus (H-ADF) lens. When the peripheral ADF zone 21 has a more negative power and brings the peripheral focus to the rear, it is called a myopic anti-defocus (M-ADF) lens. H-ADF lenses can be used to test and improve peripheral retinal visual performance problems associated with hyperopic ocular defocus, such as convergence insufficiency (CI). M-ADF lenses can be used to test and improve peripheral retinal performance problems associated with myopic ocular defocus, such as convergence excess (CE). For other types of visibility problems, ECP can be tested using either M-ADF or H-ADF lenses to determine if the problem is caused by an image discrepancy that can be improved with a peripheral ADF lens. can do.

A set of test lenses can be used to determine the anti-defocus power (ADP) of lenses according to the invention. The test set can be a series of ophthalmic lenses or contact lenses with a central optical zone 20 for distance vision of diameter 0.5-1.5 mm for contact lenses and 1.5-4.0 mm for ophthalmic lenses. The central optical zone 20 can be assigned any spherical power convenient for clinical use to add power to correct distance vision. The most common option is to apply "zero power" to the central optical zone 20, with the ADF zone 21 adjacent to the outer edge of the central optical zone 20, gradually adding or increasing outward for peripheral anti-defocus. It adds a negative frequency. The best mode for the ADF zone 21 is to gradually increase the power from the outer edge of the central optical zone 20 outward. The progressive ADF zone of the M-ADF spectacle lens may have a positive e-value (p-value < 1) at the anterior surface or a negative e-value (p-value > 1) at the posterior surface. On the other hand, the H-ADF lens has a negative e value (p value>1) at the front surface and a positive e value (p value <1) at the rear surface.

It is also possible to incorporate a progressive ADF zone 21 into the contact lens. 3 and 4, the progressive ADF zone 21 of the M-ADF contact lens has a positive e value (p value < 1) at the anterior ADF zone 21a of curvature 31a or a negative e value at the posterior ADF zone 21b. has an e value (p value > 1). The progressive ADF zone 21 of the H-ADF contact lens has a negative e-value (p-value > 1) at the anterior ADF zone 21a of curvature 31a or a positive e-value (p-value < 1) at the posterior ADF zone 21b. has. However, it is preferred that the incremental ADF zone 21a be placed on the front surface of the contact lens 10, while the back surface is attached to the ocular surface. The contact lens 10 can be a soft contact lens, a hard corneal lens (less than 12.4 mm), or a scleral lens (larger than 12.5 mm), although soft contact lenses and scleral lenses are difficult to move on the eye. This is preferable because good centering can be obtained with less.

For peripheral ocular defocus, it is necessary to look at the visual angle, field size, and image size to determine how the incoming rays are imaged onto the retinal shell. The visual or optical angle that is conjugate to the principal plane can be calculated by the formula: θ=2*arctan(S/2D), where θ is the visual angle, S is the linear size of the object, and D is the distance from the object to the eye. This is the distance to the main surface. For small angles, the image size or retinal zone width that is conjugate to the principal plane of the human eye can be expressed by the formula: image size I=[(2*π*d)*θ]/360, where d is the distance from the principal plane to the retina, and θ is the visual angle of the object. It is also possible to estimate the image size I=[2*(arctan(θ/2))*d]. The image field or incident field is forward or backward from a theoretical principal plane located approximately 5.6 mm behind the anterior surface of the corneal apex, or 17 mm in front of the center of the retina for a standard human eye of 22.6 mm. It needs to be conjugated. The axial length may increase by 1 mm for each additional -3D myopia, and the image size may also increase slightly, but this is usually not important in the design of the device.

Furthermore, when the optical device of the present invention is a contact lens, the visual angle of the retinal region is determined by the zone width on the contact lens or corneal surface, that is, the zone located 22.6 mm in front of the fovea or 5.6 mm in front of the principal surface. Can be conjugated with width. If the optical device is a pair of glasses, the viewing angle can be conjugate with the zone width on the pair of glasses, i.e., located 12 mm in front of the cornea, 17.6 mm in front of the principal surface, or 34.6 mm in front of the retina. To make the zone width conjugate to the viewing angle, 1° is 1/360 of a circle, with a 17.5 mm zone at a distance of 1 meter, or a 7 mm zone at a reading distance of 40 cm, or 17.6 mm in front of the main plane. It is conjugate with a 0.31 mm zone at a certain spectacle distance and a 0.1 mm zone on the cornea or contact lens surface, which is 5.6 mm in front of the principal surface.

As shown in Table 1 below, the 4-5 degree fovea is conjugate to a 0.5±0.1 mm zone on the contact lens surface and a 1.55±0.2 mm zone on the spectacle surface. The parafoveal 9-10° span is conjugate with the 0.85±0.1 mm annular zone on the contact lens or the 2.6±0.3 mm annular zone on the spectacle surface. The 18-20° span of the circumfovea is conjugate with a 1.8±0.2 mm annular zone on the contact lens surface or a 5.5±0.5 mm annular zone on the spectacle surface.

The zone conjugate to the foveal region forms the central zone, and the annular zone conjugate to the parafoveal and perifoveal regions and a portion of the peripheral retina form the ADF zone on the optical device. This annular zone is not limited to a circular shape. Any shape may be used as long as it is conjugate to each side of the visual axis or optical axis for a desired viewing angle and has an anti-defocus function. Therefore, we designed an ADF optical device to inspect the mismatch of central and peripheral image shells, identify the anteroposterior direction of ocular defocus, and quantify the required anti-defocus power (ADP) to improve visual acuity issues. It's very easy to do.

For hyperopic ocular defocus examination spectacle lenses, the central optical zone is zero power and has a diameter of 1.5 to 4.0 mm, with annular H-ADF zones of 8 to 12 mm on each side of the central optical zone, and a total diameter of 18 to 28 mm. It is preferable to use it at a vertex distance of 12 to 14 mm. The H-ADF zone 21 can have a negative e value (p value > 1) on the front surface, a positive e value (p value < 1) on the rear surface, and gradually increase in power toward the outside in the radial direction. The strength of anti-defocus (ADP) can be controlled with a slope e value between ±0.1e and ±2.0e. The zero power of the central optical zone 20 can be used in addition to the patient's corrected power to test for peripheral ocular defocus without changing the far vision corrected power.

For myopic ocular defocus testing spectacle lenses, the central optical zone is zero power and has a diameter of 1.5 to 4.0 mm, with annular M-ADF zones of 8 to 12 mm on each side of the central optical zone, and a total diameter of 18 to 28 mm. It is preferable to use it at a vertex distance of 12 to 14 mm. The M-ADF zone 21 can have a positive e value (p value < 1) on the front surface, a negative e value (p value > 1) on the rear surface, and gradually become negative power toward the outside in the radial direction. The strength of the anti-defocus power (ADP) can be controlled with a slope e value between ±0.1e and ±2.0e. The zero power of the central optical zone can be used in addition to the patient's corrected power to test for peripheral myopic ocular defocus without changing the distance vision corrected power.

In contact lenses for hyperopic ocular defocus testing, the central optical zone has a diameter of 0.5-1.0 mm, with an annular H-ADF zone of 3-4 mm on each side of the central optical zone, and a central to ADF zone. It is preferable that the total diameter is 6 to 10 mm, and it is used for the cornea. The H-ADF zone 21 has a negative e value (p value > 1) on the front surface for zone 21a, a positive e value (p value < 1) on the rear surface for zone 21b, and gradually increases the power outward in the radial direction. be able to. Preferably, the anterior surface of the contact lens 10 incorporates the ADF zone 21a, while the posterior surface is left only to fit the corneal surface 12. The strength of the anti-defocus power (ADP) can be controlled with a slope e value between ±0.1e and ±3.0e. The zero power of the central optical zone 20 is convenient for over-refraction in the trial frame without changing the distance vision correction power.

In contact lenses for myopic ocular defocus testing, the central optical zone has a diameter of 0.5-1.0 mm, with an annular M-ADF zone of 3-4 mm on each side of the central optical zone, and a central to ADF zone. It is preferable that the total diameter is 6 to 10 mm, and it is used for the cornea. The M-ADF zone 21 can have a positive e value (p value < 1) on the front surface 21a, a negative e value (p value > 1) on the rear surface 21b, and gradually become negative power toward the outside in the radial direction. When incorporating the ADF zone 21 into the anterior surface 21a of the contact lens 10, the posterior surface is preferably left only to fit the corneal surface 12. The strength of the anti-defocus power (ADP) can be controlled with a slope e value between ±0.1e and ±3.0e. The zero power of the central optical zone 20 is convenient for over-refraction in the trial frame without changing the distance vision correction power.

Testing procedures to identify binocular vision dysfunction can be performed by a trained ECP to obtain the information necessary for diagnosis. Before introducing an ADF lens, a checklist (Table 2) can be provided to guide the examination and record baseline visual efficiency data.

Convergence divergence system (#8, #13), fusion area (#10, #11, #16, #17), accommodation delay of accommodation system (#14, #15), accommodation power (#14, #15), #19), accommodative function, and sensory systems such as fixation disparity, associated tropism or ICS are the most important items to further evaluate the anti-defocus effect. The sensory system is the most sensitive indicator in testing ADF lenses. If initial testing does not reveal significant abnormalities in the sensory system, the convergence-divergent system may be an alternative indicator. If accommodative dysfunction is identified on initial testing and can be improved with a peripheral ADF device, the vergence system may be an auxiliary indicator.

The ADF test lens can be a series of spectacle lenses or contact lenses as described above. An ADF ophthalmic lens with an ADP gradient can be made with a loose trial lens for use with a trial frame, or an accessory that attaches to a rotating disk phoropter or similar device for quick operation. An accessory that attaches to the phoropter is preferred to easily compare subtle changes over very short periods of time between lens changes and, importantly in testing peripheral ocular defocus, to The eye can be seen reliably through the optical zone. Although ADF contact lenses with gradient ADP for testing can reliably align the central optical zone with the visual axis, it increases the time and reduces convenience when changing contact lenses. It is advisable to perform a quick investigation with ADF spectacle lenses and apply ADF contact lenses to confirm the anti-defocus strength that should be prescribed to improve the visibility problem. It may take several days to several weeks for maximum effects to be seen. The ECP will prescribe contact lenses for at-home use for at least 2 to 4 weeks according to the ADP initially obtained with the aforementioned testing device and evaluate the convergence divergence system, accommodative system, or sensory system compared to baseline visual performance data. The ADP can be rechecked and fine-tuned to optimally improve visibility issues.

If the sensory system can be used as an indicator, the procedure for checking ocular defocus is as follows. Place the fixation parallax card or device at the testing distance, apply the correction power of #7 or #14A-net/#14B-net for presbyopic patients as a control, and use the ADF spectacle lens (center zone is zero power) with the lower correction power. Gradually introduce from ADP (low ±e values) to high ADP (high ±e values) to add to forced power and check for fixation disparity/associated tropia until stable zero parallax or maximum normalization. Finally, to confirm that distance vision is not impaired by the ADF lens, recheck binocular fusion/suppression at distance and record the identified raw ocular defocus strength. When using the convergence-divergent system as an index, continuously monitor near dissociative tropia (#13) while introducing the ADF lens until #13 decreases to the normal range, then remove the vertical dissociative prism. Recheck the fusion range (#16, #17) and compare it with the residual hypoplasia (#13) of Sheard or Percival criteria. If criteria are met or significantly improved, recheck distance binocular fusion/suppression and record the resulting raw ocular defocus strength to ensure that distance vision is not compromised by the ADF lens. do. This raw ocular defocus strength can be used to select a test ADF contact lens pair with zero power in the central optical zone and immediately fine-tune any remaining ocular defocus in the exam room. Alternatively, ADF glasses or contact lenses may be prescribed and shipped based on raw ocular defocus strength, and returned to the clinic several weeks later for fine-tuning of power and ADF strength. This procedure can be repeated if fine adjustments are needed, such as when visual training (VT) is performed and the range of accommodation or fusion changes.

Corrective peripheral antifocus devices can be paired contact lenses, spectacle lenses, orthokeratology lenses, intraocular lenses (IOLs), etc., but preferred devices are contact lenses, especially soft contact lenses that have less movement during blinking. and scleral lenses. The method and device can also be used to set parameters for orthokeratology, which temporarily reshapes the cornea, and refractive surgery, which permanently reshapes the cornea to jointly correct refractive errors and peripheral ocular defocus. Can be applied. Glasses do not move with the eyeballs, making it difficult to align the center of the eye with the central zone. If the ADF device is a spectacle lens, there should be a monofocal central optical zone 20 of 2-4 mm relative to the pupil center, and an ADF zone 21 with a spherical curve with a focal point forward or backward from the central optical zone 20. Alternatively, an aspheric curve with a predetermined ±e value forward or backward from the central zone 20 may be used. The ADF zone 21 is an annular zone radially outward from the outer edge of the central optical zone 20. By setting the asphericity of the vertical meridian of the ADF zone 21 to be lower than that of the horizontal meridian (the positive e value is not low or the negative e value is not low), better visibility can be obtained. Preferably, the ADF zone 21 is a horizontal aspheric zone, and the vertical meridian single focus is left with an e value of zero to satisfy the horizontal Hering-Hillbrand deviation for fusion. Two perpendicular meridians can be blended with gradually changing e values to form a smooth optical surface.

Since the ADF contact lens can rotate on the eye, the zones of the lens are preferably rotationally symmetrical, and the ADF zone 21 of the contact lens is monofocal annular with a spherical curve having a focal point anterior or posterior to the central zone. Although it may be a zone, it is preferably an aspherical annular zone having a predetermined ±e value gradually from the central zone 20 forward or backward. The aspherical annular ADF zone 21 can be placed radially outward from the outer edge of the monofocal central zone from 0.5 to 1.5 mm, or the two zones can be continuous to prevent image skipping at the junction. The curves may be merged at their e values. By setting the asphericity of the vertical meridian of the ADF zone 21 of the contact lens 10 to be lower than that of the horizontal meridian (lower positive e value or lower negative e value), better visibility can be obtained. . Preferably, the ADF zone 21 is a horizontal aspheric zone, and the vertical meridian single focus is left with an e value of zero to satisfy the horizontal Hering-Hillbrand deviation for fusion. Two perpendicular meridians (0 degrees and 90 degrees) can be blended with gradually changing e values to form a smooth optical surface. A stabilizing structure (prismatic ballast, truncation, or dynamic stabilization) is required to align the anti-defocus zone with the correct axis, and this is required by hard and soft contact lens manufacturers in the production of toric hard or soft contact lenses. This is a well-known technology.

Control of Myopia Traditional methods for managing or controlling myopia have usually suggested softening accommodation with cycloplegics such as atropine or using ADD power bifocals for near work. . The peripheral ADF device of the present invention is very useful in slowing the progression of myopia, ie, in myopia management. In the present invention, peripheral anti-defocus is proposed to be a factor that improves the visual efficiency problem by correcting the mismatch of image shells and promotes binocular fusion. Myopia can progress rapidly if vision problems are not detected or corrected. Peripheral hyperopic eye defocus can induce convergence deficit (CI) and peripheral myopic eye defocus can induce convergence excess (CE), both conditions can induce myopia. If a CI condition is discovered during a vision test, a hyperopic anti-defocus (H-ADF) device may be used to slow or stop the progression of myopia. If CE is discovered during a visual acuity test, a myopic anti-defocus (M-ADF) device may be used to slow or stop the progression of myopia. The M-ADF lens of the present invention is similar to and different from central near (CN) multifocal lenses. A typical CN multifocal lens has a central zone for near vision with positive power added, and a zone adjacent to the central zone and radially outward from the central zone for distance vision, with a positive power less than or minus the central zone. It has a peripheral far zone with a large power. The M-ADF lens of the present invention also has a central optical zone 20, but its power is for distance vision without an additional power for near, and the outer M-ADF zone 21 has a more positive or To reduce negative power and improve peripheral myopic eyeball defocus by anti-defocusing.

Both CI and CE conditions can advance myopia through different mechanisms. In the present invention, myopia is considered to be caused by severe binocular fusion, rather than the induction of peripheral defocus to an ideal optical state as in the prior art. The present invention, contrary to the teachings of e.g. This book provides a good explanation of the research that shows that cases of myopia associated with myopia can be improved and the progression of myopia can be further slowed down.

Therefore, in this method, the binocular efficiency status is checked for myopia cases, tested using an H-ADF or M-ADF test set, and as described above, the ADP intensity for peripheral eyeball defocus and improvement is determined. do. Physicians can prescribe an ADF device with empiric ADP, perform initial adaptation at home, and fine-tune lens design or initiate VT for residual abnormalities after 1 to 2 months. The empirical ADP of the ADF zone 21 is typically 1-1.5 diopters per classically corrected prism. For example, if a CI case requires a 40 mm recovery prism and 10 ΔBI (base in), the ADP of the empirical H-ADF contact lens 10 will be +10 to +15 diopters at the outermost edge of the progressive ADF zone 21. Prescribe a pair of empiric ADF contact lenses 10 to use at home, return to the clinic 1-2 months later to re-evaluate visual acuity, and evaluate lens design, ADP, or VT can be finely adjusted. Then, for accurate binocular fusion and myopia management, glasses or contact lenses are used that improve the mismatch between the center of the eye and the peripheral image shell.

Anti-Defocus Spectacle Lens The spectacle lens according to the invention (shown in FIG. 10) has a convex front surface with a spherically curved central optical zone 20 and an ADF zone 21. The concave posterior surface of an ADF ophthalmic lens may be a spherical, aspheric, or toric lens to cooperate with the front central optical zone 20 for correction of refractive error, as is well known to ophthalmic lens manufacturers. Created. Alternatively, the ADF zone 21 can also be designed on the back surface of the spectacle lens.

In the H-ADF spectacle lens, the central optical zone 20 is a spherical power formed on the front surface (convex surface), with a diameter of 1.5 to 4.0 mm, and an annular +H- of 8 to 12 mm on each side of the central optical zone 20. There is an ADF zone 21 with a total diameter of 18-28 mm, preferably used with an apex distance of 12-14 mm. The ADP power difference between the central optical zone 20 and the outermost part of the H-ADF zone 21 is between +1.00D and +20D. The H-ADF zone 21 is progressively positive radially outward with a negative e-value (p-value > 1) on the convex front surface or a positive e-value (p-value < 1) on the concave rear surface with respect to the zone 21. Can be converted into degrees. The focal point of the H-ADF zone 21 gradually becomes shorter along the horizontal meridian, with the shortest (most negative or positive power) focal length at its outermost edge, while the vertical meridian has a single focal curvature at a constant focal length. form an e-value of zero. For smooth aspheric surfaces, the horizontal and vertical meridians are merged with gradually changing e values. The strength of the anti-defocus power (ADP) is controlled with a slope e value of ±0.1e to ±2.0e for front (myopic) peripheral focusing relative to the baseline without H-ADF lens. can do. The net ADP effect of the spectacle lens, measured in eye 14, is more myopic with a minimum of -0.50 diopter at 10 degrees on each side of the foveal retina (N10 and T10) and more myopic by 20 degrees on each side of the retinal fovea (N20). and T20) in increments up to a minimum of -2.00 diopters.

In the M-ADF spectacle lens, the central optical zone 20 is a spherical power formed on the front surface (convex surface), with a diameter of 1.5 to 4.0 mm, and an annular minus M of 8 to 12 mm on each side of the central optical zone 20. - There is an ADF zone 21 with a total diameter of 18-28 mm, preferably used with an apex distance of 12-14 mm. The difference in ADP power between the central optical zone 20 and the outermost part of the M-ADF zone 21 is between -1.00D and -20D. The M-ADF zone 21 has a positive e value (p value < 1) on the convex front surface and a negative e value (p value > 1) on the concave rear surface, and can gradually become negative power radially outward. The focus of the M-ADF zone 21 becomes progressively longer along the horizontal meridian, with the longest (most negative or positive in power) focal length at its outermost edge, while the vertical meridian has a single focal curvature at a constant focal length. form an e-value of zero. For smooth aspheric surfaces, the horizontal and vertical meridians are merged with gradually changing e values. The strength of the anti-defocus power ADP can be controlled by a gradient e value between ±0.1e and ±2.0e. The net ADP effect of the spectacle lens measured in eye 14 is more hyperopic by a minimum of +0.50 diopters at 10 degrees on each side of the foveal retina (N10 and T10) and more hyperopic by 20 degrees on each side of the retinal fovea (N20 and T10). T20) to a minimum of +2.00 diopters.

Anti-Defocus Contact Lens FIGS. 3-5 illustrate a contact lens 10 designed in accordance with the present invention, which may be a soft, hard, corneal, or scleral contact lens formed from standard contact lens materials. As shown in FIGS. 1-2, contact lens 10 is adapted to be worn on cornea 12 of eye 14 of a patient. As shown in FIG. 3, the contact lens 10 has a central optical zone (for far vision) 20 and an ADF zone (for adjusting eyeball defocus) on the convex front surface of the contact lens 10 from the center of the lens 10 toward the outer periphery. 21 and an intermediate zone 24 which may be a lenticular zone. The concave posterior surface of such an anti-defocus (ADF) contact lens 10 may be a spherical, aspheric, double geometry, or inverse geometry lens design.

Optical zone 20 has a rear surface defined by base curve 30b and a front surface defined by center curve 30a and ADF curve 31a. The front optical zone 20 of the present invention is divided into at least two concentric zones. The optical zone 20 is a central zone having a center curve 30a on the front surface, and is designed to have a refractive power for correcting far vision. The ADF zone 21 located outside the optical zone 20 has an ADF curve 31a on the front surface designed to have a refractive power for correcting peripheral ocular defocus of myopia or hyperopia. The difference between the central optical zone 20 and the ADF zone 21 is the anti-defocus power (ADP) for correcting eyeball defocus.

Although it is possible to create two adjacent annular zones in each of the central optical zone 20 and the ADF zone 21, creating small zones with significantly different powers may induce skipped images, confusion, or double vision. . Therefore, in a preferred embodiment, the two zones 20a and 21a are merged with a continuous aspherical curvature with a positive or negative eccentricity value for a smoother transition.

Optical zone 20 and ADF zone 21 preferably have a combined diameter of about 3-8 mm, more preferably 6 mm, ie 3 mm on each side of the geometric center of the lens. The lens preferably has an aspheric front optical curve 30a and an ADF curve 31a that are progressively steeper or flatter radially outward from the geometric center of the contact lens 10. The maximum anti-defocus power (ADP) of the outermost (peripheral) margin of the ADF zone 21 is preferably +3 diopters to +30 diopters for H-ADF lenses, and for M-ADF lenses if the image shell mismatch conditions are different. -3 diopter to -30 diopter. The anterior central optical zone 20a and the anterior ADF zone 21a merge smoothly, presenting a continuous anterior central to ADF zone 20a-21a with an aspherical anterior central to ADF curve 30a-31a, clearly defined in the foveal region of the eye 14. A clear central distance image is formed, and image discrepancies in the parafoveal, perifoveal, and retinal periphery are reliably corrected. The formula for calculating the e value for merging two zones is e=SIGN(R _A - R _B )*SQRT((R _A ² - R _B ² ))/(Zone A+Zone B), where Here, RR _A is the radius of curvature for the distance power, and _RB is the radius of curvature for the near power. (Zone A+Zone B) is half the zone width of each of the two zones, ie, the central optical zone 20 and the ADF zone 21.

When using a contact lens material with a refractive index of about 1.4 to 1.6 and merging the two anti-defocus zones 20a and 21a with a front ADP of +3 to +30D, the e value is usually -0.7e to -3. .0e, and in the case of front ADP -3 to -30D, it is usually +0.7e to +3.0e. Contact lens 10 needs to be precisely centered in order for the fovea to recognize light rays from central optical zone 20a so as to reduce spherical aberration.

In the case of the anti-defocus contact lens 10 for hyperopia, the front surface of the lens has a central optical zone 20 with a diameter of 0.5-1.0 mm, and 3-4 mm on each side of the central optical zone 20, with a total diameter of 6-10 mm (i.e. , the combined diameter of the optical zone 20 and the ADF zone 21). The ADP power difference between the central optical zone 20 and the outermost portion of the H-ADF zone 21 is from +1.00D to +30D. The H-ADF zone 21 is adjacent to the central optical zone 20 at the horizontal meridian 51 and starts at the same power as the central optical zone 20 and gradually increases in power along the horizontal meridian 51 with a negative e value (p value > 1). The positive value becomes larger or the negative value becomes smaller. The focal point of the H-ADF zone 21 gradually becomes shorter along the horizontal meridian, and at its outermost edge (periphery 21c) it becomes the shortest focal length (the power is the least negative or the most positive). The vertical meridian 52 is formed by a single focal point curvature with an e value of zero (p value=1). The central optical zone 20 and the ADF zone 21 may be merged at a certain e value to form a continuous central to ADF zone 20-21, as described above. The horizontal and vertical meridians 50 of the central to ADF zones 20-21 are merged with gradually varying e values to form a continuous smooth aspheric surface. The strength of the anti-defocus power (ADP) can be controlled with a slope e value between ±0.1e and ±3.0e. The net ADP effect of the contact lens 10 measured in eye 14 is more myopic with a minimum of -0.50 diopter at 10 degrees on each side of the foveal retina (N10 and T10), and more myopic by 20 degrees on each side of the fovea (N10 and T10). N20 and T20) in increments up to a minimum of -2.00 diopters.

In the case of the anti-defocus (M-ADF) contact lens 10 for myopia, the front surface of the M-ADF lens 10 has a central optical zone 20 with a diameter of 0.5 to 1.0 mm, and 3 to 4 mm on both sides of the central optical zone 20. each having an annular negative ADF zone 21 (in this case the M-ADF zone) with a total diameter of 6 to 10 mm (ie, the combined diameter of the optical zone 20 and ADF zone 21). The ADP power difference between the central optical zone 20 and the outermost portion of the M-ADF zone 21 is from -1.00D to -30D. The M-ADF zone 21 is adjacent to the central optical zone 20 at the horizontal meridian 51 and starts at the same power as the central optical zone 20 and gradually increases in power along the horizontal meridian 51 with a negative e value (p value < 1). becomes more negative or less positive. The focal point of the M-ADF zone 21 gradually becomes longer along the horizontal meridian, and has the longest focal length (the power is the least positive or the most negative) at its outermost edge (periphery 21c), while the vertical The meridian 52 is formed by a single focal point curvature with an e value of zero (p value=1). The central optical zone 20 and the ADF zone 21 may be merged at a certain e value to form a continuous central to ADF zone 20-21, as described above. The horizontal and vertical meridians 50 of the central to ADF zones 20-21 are merged with gradually varying e values to form a continuous smooth aspheric surface. The strength of the anti-defocus power (ADP) can be controlled with a slope e value between ±0.1e and ±3.0e. The net ADP effect of contact lens 10 measured in eye 14 is more hyperopic by a minimum of +0.50 diopters at 10 degrees on each side of the foveal retina (N10 and T10) and more hyperopic by 20 degrees on each side of the retinal fovea (N20). and T20) to a minimum of +2.00 diopters.

Referring to FIGS. 3-5, myopic contact lenses tend to become progressively thicker with increasing power toward the peripheral edges. To reduce the peripheral thickness of the ADF contact lens 10 of the present invention, a lenticular curve that is steeper than the curves 30a or 31a of zones 20 and 21 may be incorporated radially outward from the ADF zone 21. Contrary to myopic lenses, emmetropic, low myopic, or hyperopic contact lenses 10 have edges that are too thin and are more prone to cracking and chipping than desirable lenses, so increasing the peripheral thickness of the ADF contact lens 10 For this purpose, a lenticular curve flatter than curve 30a or 31a can be incorporated radially outward from ADF zone 21a.

Within the zone 24, for optical or therapeutic reasons, between the front ADF zone 21a and the lenticular curve, there may be one or more optional zones with a half-maximum zone width of 2.0 to 5.0 mm radially outward. You can also add intermediate zones. For example, this intermediate zone 24 can be added to have the same corrective power as the central optical zone 20, which can further intensify the peripheral distance incident light to improve distance vision at night.

The different radii used to define the base curve of the contact lens 10, i.e., the base curves of the optical zone 20, ADF zone 21, connection zone 26, and peripheral zone 28 and their relative thicknesses, are determined by the patient's Calculated after careful examination of the eye and associated ocular tissues. It is necessary to measure the corneal curvature, determine the appropriate contact lens power, and determine the expected physiological response to the contact lens 10. Those skilled in visual system inspection techniques can perform these tasks.

Anti-defocus orthokeratology
It is also an object of the present invention to provide an orthokeratology contact lens 10 that effectively improves peripheral defocus of the eye. Another object of the present invention is to provide an orthokeratology contact lens 10 that corrects refractive errors, including but not limited to hyperopia, myopia, presbyopia, and astigmatism, necessary to correct visual efficiency problems.

These objects of the present invention can be achieved by providing a device and method for correcting refractive errors associated with peripheral defocus conditions in a patient's eye. According to the method of the present invention, an anti-defocus (ADF) orthokeratology contact lens 10 (eg, shown in FIGS. 6-9) is placed on the cornea of a patient's eye, and the contact lens 10 has a corresponding curve (30a, 30b) with an anterior and posterior surface (20a, 20b), an ADF zone 21 with an ADF base curve 31b, an intermediate zone 24 (plateau zone in hyperopic lenses), a connecting or fitting zone 26, A rear surface having a plurality of zones including an alignment zone and/or a peripheral zone 28 is provided. The ADF base curve 21b flattens or steepens the curvature of the central corneal periphery such that the cornea 12 has an anti-defocus intermediate periphery surrounding the central zone formed by the base curve 20b of the optical zone 20 for distance vision. carefully crafted to make it more appealing. The target power of the optical zone 20 for distance vision correction may be determined by the ophthalmologist fitting the orthokeratology lens. The shape of the ADF zone (21a, 21b) can be derived by testing eyeball defocus using a spectacle lens for ADF testing or a contact lens for ADF testing, as described above.

According to the apparatus of the present invention, a contact lens 10 is provided, which includes an optical zone curve (30a, 30b) portion of the lens and an ADF curve (31a, 31b) of the lens circumscribed and coupled to the optical zone curve portion. and the fitting curve of the connection zone 26 portion of the lens circumscribed and combined with the plateau curve of the intermediate zone 24 and/or the ADF curve (31a, 31b) portion, and the fitting curve circumscribed and combined with the intermediate zone 24 or connection zone 26 portion. alignment curve and/or peripheral curve of the peripheral zone 28 portion of the lens.

The diameter of the central optical zone 20 of the contact lens 10 is preferably varied in the range of 1.0 to 3.0 mm depending on the purpose of correcting myopia, hyperopia, or presbyopia. The zone width of the ADF zone 21 is preferably varied from 1.0 to 4.0 mm to reshape the peripheral defocus of a given myopic or hyperopic eye on the corneal surface. The total diameter of the optical zone 20 and ADF zone 21 is preferably 4.0 to 8.0 mm, which is -0.1e for the H-ADF orthokeratology contact lens 10 to shape hyperopic ocular defocus. Aspheric optical-ADF curve with eccentricity value of ~-3.0e or +0.1e to +3.0e for M-ADF orthokeratology lens 10 to shape myopic ocular defocus on cornea 12 of eyeball 14 can be merged to result in an aspheric optical-ADF curve with an eccentricity value of .

Anti-defocus (ADF) orthokeratology contact lenses 10 are described in U.S. Patent No. 6,652,095, U.S. Patent No. 7,070,275, and U.S. Patent No. 6,543,897 Lenses can be spherical, aspherical, or two-step and inverted-shape designs for orthokeratology RGP (hard gas permeable) lenses as taught.

When treating a myopic person with peripheral hyperopic defocus, the base curve 30b is preferably flatter than the curvature of the central cornea. The central optical zone 20 and ADF zone 21 are preferably 3-4 mm in order to obtain better distance vision. For treatment of hyperopic people, it is preferable that the base curve 30b is steeper than the curvature of the central cornea. To treat presbyopia, the central optical zone 20 can be divided into two. The inner optical zone should be designed very small for near vision purposes so as not to obstruct distance vision, while the outer optical zone should be designed for clear distance vision (myopia, hyperopia, astigmatism). It should be designed slightly wider to mold the area around the central part of the cornea into a flat zone (to reduce it, if any).

The base curves (30a, 30b) and ADF curves (31a, 31b) of the contact lens 10, as well as the curves of the intermediate zone 24, connection zone 26 and peripheral zone 28, and their relative thicknesses Calculated after careful examination of the relevant ocular tissues. It is necessary to measure the corneal curvature, determine the appropriate contact lens power, and determine the expected physiological response to the contact lens 10. Those skilled in visual system inspection techniques can perform these tasks.

Anti-Defocus Refractive Surgery Another object of the present invention is to provide a method for designing parameters for performing refractive surgery (LASIK/LASEK) on the cornea 12. The anti-defocus parameter is added to correct visual efficiency problems by correcting peripheral defocus of the eye at the same time as surgically correcting hyperopia, myopia, presbyopia, and astigmatism. Similar to performing orthokeratology, the shape of the ADF zone 21 is derived by inspecting eyeball defocus using a spectacle lens for ADF examination or a contact lens for ADF examination as described above before performing surgery. be able to. The corneal shape designed in this way forms a treatment zone with a central zone that preferably varies from 1.0 to 3.0 mm for different purposes of correcting myopia, hyperopia, or presbyopia. The zone width of the ADF zone 21 adjacent to and radially outward from the central zone 20 ranges from 1.0 to 4.0 mm to correct for a given myopic or hyperopic eye peripheral defocus of the corneal surface. It can be changed within a range of .0 mm. The total diameter of the central optical zone 20 and the ADF zone 21 is preferably 5.0 to 8.0 mm, and by merging them, the eccentricity value of the eyeball 14 with respect to the cornea 12 corrects hyperopic eyeball defocus. It is possible to form an aspheric center to ADF zone 20 to 21 of -0.1e to -3.0e, and +0.1e to +3.0e when correcting myopic eyeball defocus.

LASIK/LASEK surgery is a surgery that compensates for the discrepancy between the central and peripheral images of the eye after cataract surgery, and allows different types of intraocular lenses to be inserted into both eyes. The intensity of ocular defocus can be determined using the ADF test set described above and corrected by performing LASIK/LASEK surgery.

Case 1 was an 11-year-old female who had been suffering from exotropia (XT) in which one eye shifted outwards since she was 2 years old. She underwent surgery for strabismus when she was 7 years old, but unfortunately, shortly after the surgery, she developed esotropia (ET) in which her right eye turned inward, developed double vision, and developed nearsightedness. The reason why diplopia appears after the onset of ET is that the sensory adaptations formed in XT are destroyed by the inhibitory scotoma. When I prescribed soft H-ADF contact lenses made of 55% Metafilcon, to my surprise, my eyes became straighter at both near and far distances, and my double vision disappeared. The progression of myopia also stopped for four years after wearing anti-defocus contact lenses.

<ADF soft contact lens for right eye>
Central power: -1.25D (myopia)
Center to ADF zone 20 to 21: BOZ (zone width) 8.5mm
BOZR (curvature radius) 9.0mm
FOZR (front center curve): 9.54mm
Front ADP: +10D
Horizontal front e value -1.11 (p=2.23)
Intermediate zone 24-26: Half zone width 1.16mm, radius of curvature 7.28mm
Peripheral zone 28: Half zone width 1.0mm, radius of curvature 9.8mm
<Left eye>
Central power: -0.75D (myopia)
Center to ADF zone 20 to 21: BOZ (zone width) 8.5mm
BOZR (curvature radius) 9.0mm
FOZR (center front curve): 9.43mm
Front ADP: +10D
Horizontal front e value -1.08 (p=2.17)
Intermediate zone 24-26: Half zone width 1.16mm, radius of curvature 7.28mm
Peripheral zone 28: Half zone width 1.0mm, radius of curvature 9.8mm

Although ET was surgically induced according to the theory of peripheral ocular defocus, the basic problem remains XT. The XT-suppressing scotoma for sensory adaptation was destroyed by surgery and turned into ET, resulting in diplopia and progression of myopia. Although congenital hyperopic ocular defocus induced XT, it is thought that surgery did not correct the hyperopic ocular defocus, but instead adjusted the orbicularis oculi muscle to direct the eyes inward. The peripheral image shell does not fill the fusion sphere of the panum, which is necessary to straighten and turn the eyeball inward postoperatively, resulting in the destruction of the suppressive scotoma formed for sensory adaptation in XT. , progression of double vision and myopia appeared. On the other hand, H-ADF contact lenses correct the congenital hyperopic ocular defocus, improve binocular fusion, and straighten the eyes, regardless of whether the eyes are in XT or ET position. This case shows that the strabismus in this case is secondary to peripheral ocular defocus, whereas the myopia is tertiary to the hard effort to fuse images due to diplopia that occurred after surgery. This explains how H-ADF contact lenses improved eye teaming and at the same time halted the progression of myopia.

Case 2 is a 9-year-old boy who was diagnosed with ADD (Attention Deficit Disorder) and was taking Concerta every day, but it had little effect on his reading comprehension. He had meconium aspiration with resuscitation at birth, but had no problems until he reached school age and was found unable to study. His optometrist noted that he had severe eye-tracking problems, and he underwent a visual acuity evaluation. In the SCCO test, "fixation maintenance" was rather normal, but pursuit and saccades completely failed. His refraction was emmetropia in the right eye and mild +0.50D hyperopia in the left eye. A 21-point OEP test revealed convergence deficiency (CI). The SCCO test confirmed tracking and overflow phenomena, but he was unable to follow the target, kept his arms stretched out nervously, and constantly moved his eyes upwards. Because the patient had severe oculomotor dysfunction and CI, which is extremely rare in VT, we decided to try H-ADF soft contact lenses and follow up after 1 to 2 months before starting visual training (VT).

<H-ADF soft contact lens for right eye>
Central power: Plano (zero power)
Center to ADF zone 20 to 21: BOZ (zone width) 8.5mm
BOZR (curvature radius) 9.0mm
FOZR (center front curve): 8.92mm
Front ADP: +10D
Horizontal front e value -1.06 (p=2.12)
Intermediate zone 24-26: Half zone width 1.16mm, radius of curvature 7.28mm
Peripheral zone 28: Half zone width 1.0mm, radius of curvature 9.8mm
<H-ADF soft contact lens for left eye>
Central power +0.50 (myopia)
Center to ADF zone 20 to 21: BOZ (zone width) 8.5mm
BOZR (curvature radius) 9.0mm
FOZR (center front curve): 9.17mm
Front ADP: +10D
Horizontal front e value -1.05 (p=2.10)
Intermediate zone 24-26: Half zone width 1.16mm, radius of curvature 7.28mm
Peripheral zone 28: Half zone width 1.0mm, radius of curvature 9.8mm

After wearing the H-ADF contact lenses for 2 months, SCCO tracking and saccades were rechecked. During the examination, his expression was calm and relaxed. During the examination, the limb overflow phenomenon was no longer observed. He was able to follow moving targets better and no longer rolled his eyes, except for occasionally losing his position. This showed that peripheral ocular defocus induces binocular misalignment and causes oculomotor dysfunction, which is usually misdiagnosed as a neurological or psychological problem and treated inappropriately. was. Oculomotor function improved significantly, so we arranged VT to further fine-tune visual skills.

Case 3 is a 25-year-old man with reading disability and extreme myopia. He was the best in his class until he was 17 years old in the 11th grade, but a severe headache made it difficult for him to read, and his words began to tremble after reading for even 10 minutes. As a result of studying hard at school, myopia also progressed very quickly. He tried atropine, RGP, and reading glasses to halt the progression of myopia, but to no avail. I also tried VT, but it had little effect. The condition caused anxiety and insomnia, and he was diagnosed with depression, which required antidepressants.

<Initial OEP 21-point inspection>
Refraction (#7): Right eye -15.25-3.00x170° (myopia -15.25D, astigmatism 3.0D)
Left eye -15.00-0.75@0° (myopia -15.00D astigmatism 0.75D)
Distal plagioplasty (#8) 10ΔXP (external plagioplasty)
Mesial plagioplasty (#13) 25ΔXP (external plagioplasty)
Fixation parallax (Wesson card): OD suppression at short distance Accommodation power: OD4.00D, OS3.50D
(Other visual efficiency data is not available due to severe OD suppression)

The diagnosis was convergence deficiency (CI) and accommodation deficiency (AI), which had never been diagnosed or managed before, which may have contributed to the rapid progression of myopia.

He lives outside the city and was unable to come to traditional VT. We decided to wear H-ADF soft contact lenses to improve the lack of accommodation and convergence and, if possible, slow the progression of myopia.

<H-ADF soft contact lens for right eye>
Central power: -13.50 (myopia 13.50 diopters)
Center to ADF zone 20 to 21: BOZ (zone width) 8.5mm
BOZR (curvature radius) 9.0mm
FOZR (center front curve): 13.43mm
Front ADP: +25D
Horizontal front e value -2.18 (p=5.84)
Intermediate zone 24-26: Half zone width 1.16mm, radius of curvature 7.28mm
Peripheral zone 28: Half zone width 1.0mm, radius of curvature 9.8mm
<Contact lens for left eye>
Central power: -13.50D (myopia 13.50 diopters)
Center to ADF zone 20 to 21: BOZ (zone width) 8.5mm
BOZR (curvature radius) 9.0mm
FOZR (center front curve): 13.43mm
Front ADP: +25D
Horizontal front e value -2.18 (p=5.84)
Intermediate zone 24-26: Half zone width 1.16mm, radius of curvature 7.28mm
Peripheral zone 28: Half zone width 1.0mm, radius of curvature 9.8mm

The ADF lens pair dramatically and instantly reduced near exotropia. Far 10ΔXP decreased to 6ΔXP, and near 25ΔXP decreased to 12ΔXP. An immediate fixation disparity check with the ADF lens pair revealed the absence of OD ICS with an XP (external tropia) of 9Δ at 40 cm.

The patient was sent home wearing H-ADF soft contact lenses for daytime wear, and VT was not performed. He wore contact lenses and reported that he could study comfortably throughout the day without any other aids and had no headaches. When the visual efficiency was reexamined 11 months after wearing the H-ADF lens, no progression of myopia was observed, and the visual efficiency data were almost normal.

<Re-examination of OEP 21-point examination (11 months after the initial examination)>
Refraction (#7): Right eye -15.25-3.00x170° (myopia -15.25D, astigmatism 3.0D)
Left eye -15.00-0.75@0° (myopia -15.00D astigmatism 0.75D)

<Check visual efficiency by wearing H-ADF soft contact lenses>
Distal plagioplasty (#8) 5ΔXP (external plagioplasty)
Mesial plagioplasty (#13) 12ΔXP (external plagioplasty)
Nearby convergence divergence #16A 12Δ; #16 B18/10Δ
#17A 12Δ; #17 B24/15Δ
Fixation parallax (Wesson card): Zero parallax Accommodation power OD4.25D, OS4.25D

This case shows that peripheral hyperopic ocular defocus is the etiology of convergence deficiency. ADF devices can correct optical aberrations and improve CI. Long-term use of the ADF device can improve range of motion (#16 and #17) and binocular fusion, thereby curing dyslexia and halting the progression of myopia.

Although the invention has been described in detail with respect to certain preferred embodiments, other embodiments are possible. For example, the steps disclosed in the methods of the present invention are not limiting or indicate that each step is necessarily required for the methods of the present invention, but are merely examples of steps. Therefore, the scope of the appended claims should not be limited to the description of the preferred embodiments contained in this disclosure.

Any recitation of ranges of values herein is provided merely as a shorthand way to refer to each distinct value within the range. Unless otherwise stated herein, individual values are incorporated into the specification as if individually indicated within the specification. All references cited herein are incorporated by reference in their entirety.

Reference numbers in the figures indicate the following features:

contact lenses 10
eyeglass lenses 11
cornea 12
Eyeball 14
optical zone 20
Optical zone front 20a
Optical zone rear surface 20b
Optical zone outer circumference 20c
ADF zone 21
ADF zone front 21a
ADF zone rear 21b
ADF zone outer circumference 21c
ADF zone inner boundary 22
intermediate zone 24
Connection zone 26
Surrounding zone 28
optical zone curve 30
Optical zone curve (front) 30a
Optical zone base curve (rear surface) 30b
ADF zone curve 31
ADF zone curve (front) 31a
ADF zone base curve (rear) 31b
meridian 50
horizontal meridian 51
vertical meridian 52
Horopter 60
horizontal horopter 62
Point 63 on the horizontal horopter
Panam's fusion sphere 64

Claims (24)

A peripheral eye defocus correction lens, the lens having a front surface and a rear surface,
a central zone 20 of the central portion of the lens having a lens power for correcting refractive error;
an aspherical annular anti-defocus (ADF) zone 21 adjacent to the central zone 20 and extending radially outward from the central zone 20;
The lens is a spectacle lens or a contact lens,
The front or back surface of the lens has a horizontal meridian and a vertical meridian, each of the horizontal meridian and the vertical meridian has an e value, and the vertical meridian of the ADF zone is more aspheric than the horizontal meridian of the ADF zone. A lens having a low power, characterized in that the curvature of the lens surface between said horizontal and vertical meridians is blended with a gradually changing e value to form a smooth optical surface. The lens of claim 1, wherein the e-value of the vertical meridian of the ADF zone 21 is zero. The lens according to claim 1, wherein the e-value of the vertical meridian is 1/2 or less of the e-value of the horizontal meridian. 2. The lens of claim 1, wherein the vertical meridian of the ADF zone 21 is a monofocal curve having the same power as the central zone 20. The lens is a spectacle lens, the horizontal meridian and the vertical meridian are on the front surface of the lens, the central zone has a diameter of 1.5 to 4.0 mm, and the combined diameter of the central zone and the ADF zone is 18 mm. The lens of claim 1, which is ˜28 mm. The horizontal meridian of the ADF zone is an aspherical surface, the power gradually increases radially outward from the inner boundary of the ADF zone, and has an anti-defocus power (ADP) of +1.00 to +20.0 diopters, ADP 6. The ophthalmic lens of claim 5, wherein is defined as the power difference between the outer circumference of the ADF zone 21 and the outer circumference of the central zone 20, and wherein the lens is useful for treating hyperopic ocular defocus. The horizontal meridian of the ADF zone 21 is an aspherical surface, and the power gradually becomes negative radially outward from the inner boundary of the ADF zone, and has an anti-defocus power (ADP) of -1.00 to -20.0 diopters. 6. The spectacle lens of claim 5, wherein ADP is defined as the power difference between the outer circumference of the ADF zone 21 and the outer circumference of the central zone 20, and the lens is useful for treating myopic ocular defocus. . The lens is a contact lens, the central zone has a diameter of 0.5-1.0 mm, and the ADF zone 21 extends radially outwardly from the central zone by at least 3-4 mm, and is different from the central zone 20. A lens according to claim 1, wherein the combined diameter of the annular ADF zone 21 is between 6 and 10 mm. The front or rear surfaces of the central zone 20 and the ADF zone 21 each have an e value, and the e values of the central zone and the ADF zone are merged to form the aspherical center to ADF zones 20 to 21, 9. The horizontal meridian and vertical meridian of the central to ADF zone 20-21 are merged with a rotationally progressive e value to form a central to ADF zone having a continuous and smooth aspheric surface. contact lens. The rotational progression e value E _x along the axis X° of the center to ADF zone is:
E _x =SIGN(XR _p -R _c )*(ABS(XR _p ² -R _c ² )) ^1/2 /d (Equation 2.2),
where XR _p is the radius of curvature at the radially outer point along axis X ^o at distance d, and XR _p is
XR _p =HR _p +sin(X ^o ) ² *(VR _p −HR _p ) (Equation 2.1), where:
R _c is the radius of curvature at the center of the contact lens,
HR _p is the radius of curvature at a radially outer point along the horizontal meridian at distance d;
10. The contact lens of claim 9, wherein VR _p is the radius of curvature at a radially outer point along the vertical meridian of distance "d." The vertical meridian has an e-value of zero and has a monofocal power throughout the center to ADF zone 20-21, and the e-value of the horizontal meridian is not zero and is between ±0.1e and ±3.0e. 10. The contact lens of claim 9. 12. The contact lens according to claim 11, for use in the treatment of hyperopic ocular defocus, wherein the horizontal meridian gradually increases in positive power radially outward from the central portion of the lens, and has an anti-defocus power (ADP). ) is +1.00 to +30.0 diopters, ADP is defined as the difference in degrees between the outer circumference of the ADF zone 21 and the outer circumference of the central zone 20, and the front side of the horizontal meridian is -0.1e to - A lens having an e-value of 3.0e, or wherein the rear surface of said horizontal meridian has an e-value of +0.1e to +3.0e. 12. The contact lens according to claim 11, for use in the treatment of myopic ocular defocus, wherein the horizontal meridian gradually becomes negative power radially outward from the central portion of the lens, and has an anti-defocus power (ADP). ) is between −1.00 and −30.0 diopters, ADP is defined as the difference in degrees between the outer circumference of the ADF zone 21 and the outer circumference of the central zone 20, and the front side of the horizontal meridian is between +0.1e and A lens having an e-value of +3.0e, or wherein the back surface of said horizontal meridian has an e-value of -0.1e to -3.0e. 9. The contact lens according to claim 8, used for performing orthokeratology, wherein the horizontal meridian and the vertical meridian are on the posterior surface of the lens to achieve corneal shaping, and the e-value of the ADF zone is ±0. Contact lenses that are 1e to ±3.0e. The contact lens according to claim 8, further comprising:
an intermediate zone 24 coupled to the ADF zone 21 and extending radially outward from the ADF zone 21 and having a zone width of 2.0 to 5.0 mm;
a connection zone 26 coupled to and extending radially outwardly from the intermediate zone 24 for supporting the contact lens on the cornea;
a peripheral zone 28 coupled to the outer periphery of the contact lens. 9. A contact lens according to claim 8, wherein the lens is a hard corneal lens, a hard scleral lens or a soft contact lens. A method of correcting peripheral ocular defocus in an eye of a subject to improve or improve visual performance problems, the method comprising:
(a) An anti-defocus (ADF) zone 21 for a lens having a central zone 20 in a central portion of the lens and an anti-defocus (ADF) zone 21 adjacent to said central zone 20 and extending radially outward from said central zone 20; determining a power (ADP), wherein the central zone has a central focus for forming a central image in the retinal fovea for correcting refractive error, and the ADP is determined by the outer periphery of the ADF zone 21 and the central The determined ADP, defined as the power difference between the outer circumference of the zone 20, offsets the peripheral ocular defocus of the subject's eye and reshapes the peripheral image to improve peripheral fusion and visual efficiency. is sufficient to adjust the steps, and
(b) providing the lens to the subject;
A method characterized by comprising: The step of determining the anti-defocus power (ADP) includes:
(i) checking baseline visual efficiency data of the subject;
(ii) selecting an ADF test lens based on the type of visual acuity problem the subject has;
(iii) Examining the raw ocular defocus strength by gradually introducing said ADF test lens from a lower ADP to a higher ADP until the optimal ADP that achieves maximum normalization of the visual performance data is determined. step and
(iv) providing the subject with ADF glasses or contact lenses having an optimal ADP;
18. The method according to claim 17. The method according to claim 18, further comprising:
The method comprises repeating steps (i) to (iv) after the subject wears the provided glasses or contact lenses for a predetermined period of time. The horizontal meridian of the ADF zone 21 is an aspheric surface, the ADF zone has an ADP of +1.00 to +20.0 diopters, and the ADF zone has an ADP of +1.00 to +20.0 diopters; 18. The method of claim 17, wherein the lens is used to improve binocular vision problems or to control myopia in cases of hyperopic ocular defocus. The horizontal meridian of the ADF zone 21 is an aspherical surface, and the degrees are progressively negative radially outward from the inner boundary of the ADF zone, and the ADF zone has an ADP of −1.00 to −20.0 diopters. 18. The method of claim 17, wherein the lens is used to treat myopic ocular defocus. An ADP effect of a minimum of 0.50 diopters relative to the front (more nearsighted) or backwards (more farsighted) of said subject in peripheral focus measured at 10 degrees on either side (N10 and T10) of said subject's retinal fossa. 18. The method of claim 17, further comprising inducing the eye. An ADP effect of a minimum of 2.00 diopters relative to the front (more nearsighted) or backwards (more farsighted) of said subject in peripheral focus measured at 20 degrees on either side (N20 and T20) of said subject's retinal fossa. 18. The method of claim 17, further comprising inducing the eye. 18. The method of claim 17, wherein the method treats a visual performance problem selected from the group consisting of oculomotor dysfunction, accommodative dysfunction, vergence divergence movement disorder, and sensory adaptation abnormality.

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